Senior Coordination of Benefits Specialist

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.

Job Summary:

The Coordination of Benefits (COB) Senior Specialist is responsible for optimizing COB recovery efforts by identifying and investigating WellSense members for other insurance coverage. The Senior Specialist is responsible for partnering with our providers and members to respond to and resolve incoming COB inquiries and appeals. The Senior Specialist is expected to take complete responsibility for every interaction with a provider and a member by providing outstanding service. The Senior Specialist is responsible for achieving the highest level of production and accuracy in all functions, including the 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. Is able to resolve all but the most complex inquiries without assistance.
• Works independently and with minimal supervision to achieve the highest set productivity metrics for investigating members for other insurance.
• Processes COB claims in Facets at the highest set production metric with minimal assistance from team lead or manager. Consistently achieves superior quality scores.
• Processes all departmental reports quickly with a high level of accuracy and reports finding 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 members.
• Consistently identifies additional methods for increased recoveries through interactions with internal and external customers

Supervision Exercised:

* Provides technical supervision to less experienced staff as needed.

Supervision Received:

* Indirect supervision is received weekly.

Qualifications:

Education Required:

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

Experience Required:

* Four or more years of progressively responsible experience in a healthcare or managed care field required.

* Extensive knowledge of Facets claim processing required.

* Extensive knowledge of all BMCHP COB practices required.

* A proven track record of consistently achieving at the highest level of COB productivity required.

Experience Preferred/Desirable:

* Experience in a Medicaid MCO setting highly preferred.

Required Licensure, Certification or Conditions of Employment:

* Successful completion of pre-employment background check

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. 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:

• Regular and reliable attendance is an essential function of the position.
• Ability to work OT during peak periods.
• Work is normally performed in a typical interior/office work environment.
• No or very limited physical effort required. No or very limited exposure to physical risk.

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 is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees