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Coordination of Benefits
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose:
Ensure accuracy of payments and/or denials related to COB or overpayment recovery processes and are made in accordance with company protocols and procedures. Using multiple sources, this position researches Coordination of Benefits (COB) including Explanation of Benefit (EOB) documentation for potential dual coverage by other health insurance companies for all subscribers, spouses and affected dependents and determines which insurance is prime. COB research extends to all coverage offered by all lines of business and platforms.
Calls hospitals, insurance companies, medical groups and/or members requesting other insurance information as it pertains to dual coverage, eligibility and termination dates of coverage.
Researches various COB information from lead sources including but not limited to Member Enrollment Forms, returned member request letters, prior claims, authorizations and Call Center Contacts.
Makes COB determinations in accordance to COB guidelines (NAIC, CMS, DMHC, DOI or other resources).
Updates the COB master file with other insurance information.
Sends correspondence to members requesting COB information.
Identifies need to re-adjudicate claims for members when Centene is secondary.
Role includes transactional duties related to provider overpayment recovery processes as assigned.
Performs other duties as assigned.
Complies with all policies and standards.
Education/Experience: High School Diploma or equivalent required. Associate's Degree preferred. 1+ years experience in health insurance industry; prior experience in claims working with coordination of benefits processes preferred and or one year experience in a customer service environment required.1+ years experience using computers with Microsoft Office proficiency required. 1+ years experience with Medicaid or Medicare claims preferred.
Pay Range: $19.43 - $32.98 per hourCentene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
