Anthem eCOB Specialist I - III - USA - Remote - PS6045 in Apple Valley, California
eCOB Specialist I - III - USA - Remote - PS6045
Location: United States
Requisition #: PS6045
Post Date: May 04, 2018
Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care .
This is an exceptional opportunity to do innovative work that means more to you and those we serve atone of America's leading health benefits companies and a Fortune Top 50 Company.
eCOB Specialist I- III - PS6045
This opportunity has the flexibility to work from home or at any Anthem office. If you currently work from an Anthem office
you would remain onsite until eligible to work from home.
Responsible for researching and investigating other coverage for all of the company's groups and member 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.
Aide’s 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 of 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 adjudicate impacted claims, using multiple COB Formulas for the
various product types, pursuant to State and Federal Guidelines.
- Handles complex case research and resolution. May assist with training of new associates.
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.
Knowledge of Anthem ACES claims system preferred
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.