WellSense Health Plan
Coordination of Benefits Verification Specialist I or II
WellSense Health Plan, Boston, Massachusetts, us, 02298
Coordination of Benefits Verification Specialist I or II
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 COB Verification Specialist plays a vital role in maintaining the accuracy and integrity of member insurance data. This position is responsible for the timely and precise review of internal and external Coordination of Benefits data files, ensuring that WellSense members’ other insurance information is up-to-date and correctly reflected in our systems. Our Investment In You
Full-time remote work Competitive salaries Excellent benefits Key Functions/Responsibilities
Contact members, providers, employers, and other carriers to verify active insurance coverage Update and maintain member coverage records in claims systems and COB databases Investigate coverage discrepancies to determine primary vs secondary insurance Communicate with insurance carriers and healthcare providers to obtain other coverage information Perform simple claim adjustment Communicate with healthcare providers to resolve claims processing inquiries Identify and implement process improvements that minimize claim delays and errors Qualifications Education Required:
High School Diploma (or equivalent/GED) Experience Required One or more years (i.e., office, administrative, clerical, customer service, etc.) using phones and computers as primary tools. Minimum of two (2) years of experience working in health insurance or similar role. Minimum of one (1) year of Medicaid/Medicare experience Minimum of one (1) year of Verification process experience Minimum of six (6) months claims experience Experience Preferred/Desirable One (1) year Claims Processing (TriZetto: Facets/QNXT) Competencies, Skills, And Attributes
Oral and written communication skills Working knowledge of Microsoft Office products. Demonstrated ability to navigate across various computer systems Detail-oriented 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
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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 COB Verification Specialist plays a vital role in maintaining the accuracy and integrity of member insurance data. This position is responsible for the timely and precise review of internal and external Coordination of Benefits data files, ensuring that WellSense members’ other insurance information is up-to-date and correctly reflected in our systems. Our Investment In You
Full-time remote work Competitive salaries Excellent benefits Key Functions/Responsibilities
Contact members, providers, employers, and other carriers to verify active insurance coverage Update and maintain member coverage records in claims systems and COB databases Investigate coverage discrepancies to determine primary vs secondary insurance Communicate with insurance carriers and healthcare providers to obtain other coverage information Perform simple claim adjustment Communicate with healthcare providers to resolve claims processing inquiries Identify and implement process improvements that minimize claim delays and errors Qualifications Education Required:
High School Diploma (or equivalent/GED) Experience Required One or more years (i.e., office, administrative, clerical, customer service, etc.) using phones and computers as primary tools. Minimum of two (2) years of experience working in health insurance or similar role. Minimum of one (1) year of Medicaid/Medicare experience Minimum of one (1) year of Verification process experience Minimum of six (6) months claims experience Experience Preferred/Desirable One (1) year Claims Processing (TriZetto: Facets/QNXT) Competencies, Skills, And Attributes
Oral and written communication skills Working knowledge of Microsoft Office products. Demonstrated ability to navigate across various computer systems Detail-oriented 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
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