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.

The Coordination of Benefits (COB) Specialist is responsible for optimizing COB recovery efforts by identifying and investigating health plan members for other insurance coverage. The COB Specialist is responsible for partnering with our providers and members to respond to and resolve incoming COB inquiries and appeals. The Specialist is expected to take complete responsibility for every interaction with a provider and a member by providing outstanding service. The Specialist is also responsible for accurate and timely processing of COB claims, completing activity reports, communicating COB policies to internal and external sources, and supporting the recovery efforts of the department.

Our Investment in You:

• Full-time remote work
• Competitive salaries
• Excellent benefits

Key Functions/Responsibilities:

• Responds to provider and member phone calls and correspondence including but not limited to claim adjustments requests, appeals, corrected claims, timely filings and projects
• Investigates members for other insurance through phone calls, questionnaires, provider inquiries and claims in order to optimize savings to the Plan
• Accurately processes COB claims in Facets, including retractions, denials, repayments and secondary balances
• Processes all departmental reports in an accurate and timely manner and reports findings to the team lead and manager
• Participates in departmental meetings and assists in the development of workflow and process improvements
• Assists in internal departmental training programs on COB and participates in the training of new COB team members
• Identifies additional methods for increased recoveries through interactions with internal and external customers

Qualifications:

Education:

• Bachelor’s Degree in Business, Healthcare Administration or related fields; or an equivalent combination of education, training, and experience is required

Experience:

• Four or more years of progressively responsible experience in a healthcare or managed care field required
• Experience in COB claims processing, and experience in a Medicaid MCO setting highly preferred

Competencies, Skills, and Attributes:

• Proficient PC skills including all Microsoft Office products required
• Candidate must be able to multi-task and prioritize work
• Must have excellent verbal and written communication skills, organizational skills and customer service skills
• The COB Specialist must demonstrate initiative for process improvement and have the ability to provide direction and feedback to co-workers
• Ability to work both as a team member and independently

Working Conditions and Physical Effort:

• Ability to work OT during peak periods

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 will require proof of COVID-19 vaccination(s) as a term of employment for all employees. The company may make exceptions to this requirement in certain limited circumstances for religious or medical purposes.

Required Skills

Required Experience