Coordination of Benefits Verification Specialist I or II

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It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary:

The COB Verification Specialist plays a vital role in maintaining the accuracy and integrity of member insurance data. This position is responsible for the timely and precise review of internal and external Coordination of Benefits data files, ensuring that WellSense members’ other insurance information is up-to-date and correctly reflected in our systems.

Our Investment in You:

·       Full-time remote work

·       Competitive salaries

·       Excellent benefits

Key Functions/Responsibilities:

• Contact members, providers, employers, and other carriers to verify active insurance coverage
• Update and maintain member coverage records in claims systems and COB databases
• Investigate coverage discrepancies to determine primary vs secondary insurance
• Communicate with insurance carriers and healthcare providers to obtain other coverage information
• Performs simple claim adjustment
• Other duties as assigned
• Performs simple claim adjustment
• Communicate with healthcare providers to resolve claims processing inquiries
• Identify and implement process improvements that minimize claim delays and errors

Supervision Exercised:

• None

Supervision Received:

• Close supervision received daily

Qualifications:  

Education Required:  

• High School Diploma (or equivalent/ GED)

Experience Required:

• One or more years (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as primary tools.
• Minimum of two (2) years of experience working in health insurance or similar role.
• Minimum of one (1) year of Medicaid/Medicare experience
• Minimum of One (1) year of Verification process experience
• Minimum of six (6) months claims experience

Experience Preferred/Desirable:

• One (1) year Claims Processing (TriZetto: Facets/QNXT)

Required Licensure, Certification or Conditions of Employment:

• None

Competencies, Skills, and Attributes:

• Oral and written communication skills
• Working knowledge of Microsoft Office products.
• Demonstrated ability to navigate across various computer systems
• Detail oriented

Working Conditions and Physical Effort:

• Ability to work OT during peak periods.
• Regular and reliable attendance is an essential function of the position.
• Work is normally performed in a typical interior/office work environment.
• No or very limited physical effort required. No or very limited exposure to physical risk.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees

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