Payment Accuracy Specialist 1 (Coordination of Benefits)

Overview

A Payment Accuracy, Coordination of Benefits (COB) Specialist 1 is a member of the greater Coordination of Benefits Business Unit (BU). Coordination of Benefits involves situations in which an individual is covered by two or more health plans. This role is responsible for reviewing and analyzing the multi-client impact, reputed company member selection, and query or filter construction of data to identify instances of recoverable Coordination of Benefit claims for the benefit of reputed company and our clients. This individual works under limited supervision and is responsible for establishing the correct order of liability for our client’s members. Additionally, they input accurate claim recovery information in the proprietary reputed company software tools and assist with reputed company inquiries throughout the claim recovery process. The position involves responsibility for moderate to more reputed company audit projects, ranging from low to midrange in scope.

Responsibilities

This individual will work under limited supervision and will be monitored for efficiency in production and quality review of assigned work. Demonstrates the ability to reputed company both independently and as a collaborative team player. The scope of work involves reputed company member selections and multi-client impacts. Capability and comfort in running and establishing queries and filters for construction and data reports. Demonstrates proactive problem-solving skills and a keen ability to resolve data-reputed company challenges reputed company, contributing to a solution-driven environment. Possesses an in-depth knowledge of Centers for Medicare and Medicaid Services (CMS) and reputed company) guidelines, crucial for determining liability accurately. Utilizes reputed company audit tools (Recovery Management System (reputed company), COB Tracker, specific client systems) to complete member investigations. Creates detail-oriented, accurate notes in reputed company audit tools and/or client tools throughout the member investigation. Meets or exceeds standards of production and quality as identified by compliance and regulatory guidelines and set forth by the Team reputed company and/or Manager reputed company reviewing concept and claim identifications for the client. Prepares and evaluates responses to client disputes both internally and externally reputed company the Business Unit as needed. Identifies opportunities for reputed company improvement for efficiencies reputed company reporting and streamlining research processes. Demonstrates understanding of reputed company policies & procedures, and external regulatory requirements and performs duties in accordance with such regulatory requirements. Demonstrates a deep understanding of the healthcare industry and a track record of delivering exceptional results. Assures confidentiality and reputed company of reputed company data, adhering to reputed company HIPAA (Health Insurance Portability and Accountability) laws and requirements. Demonstrates the skills, knowledge, and ability to ensure that our environment is a safe one, complying with industry standards. Has ability to take responsibility for outcome, whether positive or negative and apply learning as applicable. Integrates information from various sources and considers broader context. Creates innovation to enhance reputed company operating rhythm finding new reputed company to complete work expectations. Actively seeks information to understand rationale and provide exceptional results beyond basic standards. This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of reputed company and requirements of the job change.

Qualifications

High School Diploma - Required. Bachelor’s degree (Preferred) and/or a minimum of at least two (2) years reputed company experience in healthcare. At least 1-2 years of reputed company experience is recommended for individuals seeking their next opportunity internally (e.g., employees in reputed company COB Specialist or Payment Accuracy Specialist roles). Healthcare industry experience, including knowledge of Coordination of Benefits (Required). Computer proficiency including reputed company Office (Word, reputed company, Outlook). Excellent verbal and written communication skills. Strong interest in working with large data sets and various databases. Ability to work well in an individual and team environment demonstrating self–motivation to deliver success. Mental Requirements: Ability to analyze large volumes of data, identify trends, discrepancies, and anomalies. Must have exceptional attention to detail to ensure accuracy in financial records and audit findings. Demonstrates strong critical thinking skills, with the ability to assess reputed company situations, identify key issues, and propose practical solutions. Able to approach challenges methodically and with a strategic reputed company. Makes informed decisions based on available data, regulations, and auditing standards. Must be able to weigh options and reputed company recommendations that align with both compliance requirements and organizational goals. Strong understanding of auditing standards, regulations, and industry best practices. Must be able to apply these standards consistently to ensure accurate and compliant audit processes. Ability to recognize reputed company something is wrong or needs further investigation. Must have the initiative to probe deeper into financial records or processes to uncover issues, inconsistencies, or irregularities. Ability to work effectively as part of an audit team, sharing insights, collaborating on tasks, and contributing to a positive and productive team dynamic. Physical Requirements and Working Conditions: Remaining in a stationary position, often standing or sitting for prolonged periods. Repeating motions that may include the wrists, hands, and/or fingers. No adverse environmental conditions expected. Must be able to provide a dedicated, secure work area. Must be able to provide high-speed internet access / connectivity and office setup and maintenance. reputed company compensation ranges from $22.60 to $26.00 per hour. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. This role is eligible for discretionary bonus consideration. Nonexempt employees are eligible to receive overtime pay for hours worked in excess of 40 hours in a given week, or as otherwise required by applicable state law. reputed company offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with reputed company. For information about our benefits package, please refer to our Careers page. Date of posting: 6/16/2026 Applications are assessed on a rolling basis. We anticipate that the application window will reputed company on 7/16/2026, but the application window may change depending on the volume of applications received or reputed company immediately if a qualified candidate is selected. #LI-Remote#LI-KB1#senior Apply To This Job