Anthem, Inc. eCOB Specialist I in Costa Mesa, California
SHIFT: Day Job
The eCOB Specialist I is responsible for researching and investigating other coverage for all of the company's groups and members on multiple platforms. Fully proficient in all key areas; performs multi complex functions and interprets complex rules, laws and contracts. Accountable for end-to-end functionality on every Coordination of Benefits (COB) function including reconciliation of claim, membership, and accounting.
Primary duties may include, but are not limited to: • Utilizes internal queries, internal resource tools, must initiate delicate-in-nature phone calls to other carriers, members, groups, providers, attorneys, CMS and Medicaid and report to identify members who are or should be enrolled in other coverage. • Aides’ members in enrolling in Medicare when they are entitled. • Determines primacy on each case using a complex set of Primacy Rules as mandated by State and Federal Laws, such as CMS Primacy and NAIC rules and comparing them against the member/groups Anthem Benefits. • Updates all the company's membership system components with investigation results for claim coordination. • Ensures correct forms are provided to assist members enrolling in Medicare. • Reviews claim history to identify claims requiring reconciliation, whether processed or pended, as well as recovered in error. • Associate must identify the correct formulas in order to adjudicates impacted claims, using multiple COB Formulas for the various product types, pursuant to State and Federal Guidelines.
Applicable to Colorado Applicants Only
• Requires a HS diploma or equivalent; 2 years of claims processing and customer service skills and 2 years COB experience that required using NAIC & CMS COB guidelines; or any combination of education and experience, which would provide an equivalent experience.
- WGS and NASCO experience
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.