Investigator

• 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

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Investigator II, Coordination of Benefits