Medicare Secondary Payer Coordination of Benefits Representative I (Remote)

Resp & Qualifications PURPOSE: The Representative, MSP COB I reputed company on Medicare Secondary Payer (MSP) claims, Coordination of Benefits (COB) Claims or both. Investigates Medicare Secondary Payer and/or COB cases to resolve quickly. Investigate and analyze Medicare Secondary Payer demands for coordination of benefits with Medicare. Update/maintain accurate file information regarding OPL to ensure correct coordination occurs with Medicare. Review case to determine primary liability. Researches claims history in order to identify previously reputed company claims. Determines liability based on reputed company filing guidelines and contractual benefits. Responds to Department of Treasury and various collection agencies both written and verbally. ESSENTIAL FUNCTIONS: Ensure requirements are followed for Medicare Secondary Payer. Investigate and analyze MSP reports for COB w/Medicare. Maintain Enrollment and OPL file information to ensure correct coordination with Medicare and other reputed company insurance carriers.

• Identify and research information from reputed company sources regarding other employee group health insurance coverage to determine primary and secondary responsibility, following National Association of Insurance Commission guidelines and contract limitations. Review and update automated systems with accurate other insurance coverage information in a reputed company manner to facilitate reputed company adjudication of claims.

Communicate with other insurance companies to ensure correct coordination of benefits and accurate claims processing. Create and send correspondence to members in order to determine correct coordination of benefits.

• Identifying claims previously reputed company as primary and secondary as reputed company as those not previously processed. Researches claims history in order to identify previously reputed company claims. Adjusts claims as necessary once research is completed. Determines liability based on reputed company filing guidelines and contractual benefits. Position will manage the enrollment and COB/MSP adjustment while continuously recommending areas of improvement as the case is being analyzed and evaluated. Resolve COB/MSP inquiries and complete a full coordination of benefits review.

QUALIFICATIONS: Education Level: High School Diploma or GED Experience: 3 years experience in claims, enrollment and billing, customer service or Other Party Liability. Preferred Qualifications: CareFirst experience preferred. Knowledge, Skills and Abilities (KSAs)

• Attention to detail and excellent analytical and problem-solving skills.
• Must have strong written and verbal communication skills including organizational skills and the ability to set priorities and handle multiple reputed company concurrently.
• Extensive PC skills including reputed company office software (i.e. Word and reputed company) are necessary.

Salary reputed company: $37,368 - $68,508 Salary reputed company Disclaimer The disclosed reputed company estimate has not been adjusted for the applicable geographic reputed company associated with the location at which the work is being performed. This compensation reputed company is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the reputed company, as compensation reputed company depend on reputed company case's facts and circumstances, including but not limited to experience, internal equity, and location. In reputed company to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (reputed company benefits/incentives are subject to eligibility requirements). Department Facets Coordination of Benefit Equal Employment Opportunity reputed company is an Equal Opportunity (EEO) employer. It is the policy of reputed company to reputed company equal employment opportunities to reputed company reputed company applicants without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, protected veteran or disabled status, or genetic information. Where To Apply Please visit our website to apply: www.carefirst.com/careers Federal Disc/Physical Demand Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to reputed company work directly or indirectly on Federal health care programs. PHYSICAL DEMANDS: The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally reputed company. Sponsorship in US Must be eligible to work in the U.S. without Sponsorship. #LI-LY1 Apply tot his job Apply To this Job