COB Specialist, Payment Integrity

Hi, we're [Employer]. We're hiring a COB Specialist to join our Payment Integrity team.

[Employer] is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started [Employer] in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role:

You will be responsible for supporting Coordination of Benefits (COB) efforts for Payment Integrity. This role is responsible for investigating and verifying proper payment of [Employer] medical and pharmacy claims. You will create new COB workflows, enhance existing and drive COB audits.

You will report into the Manager, Payment Integrity.

Work Location: This is a remote position, open to candidates who reside in: Atlanta, Georgia; Chicago, Illinois; Dallas, Texas; Louisville, Kentucky; Minneapolis, Minnesota; Philadelphia, Pennsylvania; Salt Lake City, Utah. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area.

Pay Transparency: The base pay for this role is: $64,832 - $85,092 per year. You are also eligible for employee benefits, participation in [Employer]'s unlimited vacation program and annual performance bonuses.

Responsibilities:

• Contribute as a subject matter expert for Oscars COB reimbursement policies
• Respond to internal and external inquiries and disputes regarding COB policies
• Use knowledge gained through research and claims review to ideate COB opportunities. Translate into business requirements; submit to and collaborate with internal partners to effectuate change.
• Ingest information from internal and external partners regarding adverse claim outcomes; collaborate with partners to scope, size, prioritize items and deliver COB solutions.
• Use insights from partner submissions, process monitoring, etc., work with the team to proactively identify thematic areas of opportunity to solve COB problems.
• Perpetuate a culture of transparency and collaboration by keeping stakeholders well informed of progress, status changes, blockers, completion, etc.; field questions as appropriate.
• Support [Employer] run state objectives by providing speedy research, root cause analysis, training, etc. whenever issues are escalated and assigned by leadership.
• Analyze, investigate and confirm if dual coverage exists for [Employer] membership
• Utilize data analysis skills and tools to develop accurate, quantitative analyses of payment issues
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• A bachelor's degree or 4+ years of commensurate experience
• 4+ years of experience in payment integrity, ideally coordination of benefits
• Experience with coordination of benefits reimbursement methodologies, provider contract concepts and common claims processing/resolution practices.
• 2+ years experience deriving business insights from datasets and solving problems
• 1+ years experience improving business workflows and processes
• 1+ years experience collaborating with internal and/or external stakeholders

Bonus points:

• 2+ years of experience working with large data sets using excel or a database language, preferably SQL.
• Experience with pharmacy coordination of benefits
• Experience in a professional healthcare claims organization
• Knowledge management, training, or content development in operational settings

This is an authentic [Employer] Health job opportunity.

At [Employer], being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: [Employer] applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any [Employer] applicant who requires reasonable accommodations during the application process should contact the [Employer] Benefits Team () to make the need for an accommodation known.

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Originally posted on [Employer]