Anthem, Inc. eCOB Specialist I in Reston, Virginia
SHIFT: Day Job
The eCOB Specialist I is responsible for researching and investigating other coverage for all of the company's groups and members 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. • Aides’ 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 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 adjudicates impacted claims, using multiple COB Formulas for the various product types, pursuant to State and Federal Guidelines.
• 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.
- WGS and NASCO experience
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.