FREE ACCESS
5,000–10,000 jobs/day
See all jobs on JobTailor
Search thousands of fresh jobs every day.
Discover
- Fresh listings
- Fast filters
- No subscription required
Create a free account and start exploring right away.
Investigator II, Coordination of Benefits
Elevance HealthInvestigating coordination of benefits for Elevance Health, a healthcare services organization. Ensuring accurate claims processing and communication with stakeholders across various data sources.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in COB investigations, claims processing, and compliance with Medicare Secondary Payer regulations. Proficient in data analysis and client communication, ensuring accuracy in claims adjudication and stakeholder engagement.
Highest-signal resume keywords
COB Investigation ExperienceClaims ProcessingMedicare Secondary Payer (MSP) KnowledgeAdvanced Negotiation & Dispute ResolutionData Analysis Tools Proficiency
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims ProcessingCOB InvestigationData AnalysisAttention to DetailClient-Specific COB Methodologies
Soft Skills
Self-MotivatedTeam CollaborationCommunication Skills
Tools & Technologies
Microsoft Office SuiteExcelClaims Processing SoftwareSQL
Industry Keywords
Medicare Secondary Payer (MSP)NAIC GuidelinesERISAVendor SLAsEmployer Group Contracts
Tech Stack
Tools & technologiesSQL
About the role
Key responsibilities & impact- Conduct in-depth COB investigations to establish primary and secondary coverage
- Analyze comprehensive data sources such as COB Smart, HEW, claims, and membership data
- Navigate and adapt to multiple internal and external client systems
- Initiate and manage sensitive communications with stakeholders
- Ensure accuracy in membership data updates
- Apply client-specific COB methodologies for appropriate claims adjudication
- Identify and rectify incorrectly paid claims
- Maintain compliance with vendor SLAs, state and federal guidelines, and employer group contracts
- Perform additional duties as necessary to support vendor operations and client services
Requirements
What you’ll need- Requires a H.S. diploma or equivalent
- Minimum of 2 years of claims processing and/or customer service experience
- At least 2 years of experience in claims processing and customer service highly desired
- 2 years of COB investigation experience is desired
- Strong understanding and application of Medicare Secondary Payer (MSP), NAIC guidelines, ERISA, and other relevant regulations
- AA/AS or higher level degree in healthcare administration or insurance is preferred
- Proficiency in Microsoft Office Suite, specifically Excel, Word, Outlook, and Teams
- Experience with claims processing software and SQL/data analysis tools is preferred
- Expertise in Advanced Negotiation & Dispute Resolution, particularly in handling COB appeals and coverage disputes
- Self-motivated with ability to prioritize and manage high-volume caseloads, adhering to strict SLAs
- Strong team collaboration skills
- Exceptional attention to detail