Coordination of Benefit Representative
Location: Orange, California US
Job Number: 2860
Position Title: Coordination of Benefit Representative
The Coordination of Benefit Representative assists in the day-to-day responsibilities of the various sections within the Membership Unit. The Representative ensures that all of the COB and MSP files from CMS are properly loaded in EZ-Member, as well as coordinating of benefits between AHP and other coverage.
(May include but are not limited to)
- Responsible for the upload of the daily files from CMS into EZ- Member.
- Updating and deleting members other coverage through COB contractor via ECRS.
- Ensure members file is flagged with the proper coverage. (primary or secondary)
- Ensure all COB data is transferred into EZ-Cap.
- Responsible for surveying current members with other coverage on a yearly basis as well as new members.
- Collaborate with I.T. on creating reports and any system updates as per CMS guidelines.
- Collaborating with the Claims Department on other coverage discrepancies or updates.
- Contact other insurances to verify members’ coverage or members to obtain proof of coverage.
- Update COB/ MSP policy and standard operation procedures (SOP) as needed.
- Collaborate with the Eligibility Department on coverage discrepancies.
- Assist in the day-to-day activities for any section within the Membership Unit. The responsibilities are to provide support including any of the following, filing, typing, data entry, and mailing of various forms of communications to our members. As well as outbound calls, the sending of facsimiles and/or e-mail communications.
- Assist in the processing the Weekly Transaction Reply Report (TRR) and Monthly TRR. Mailing of weekly and monthly notification of letters to the members and ensure proper documentation is added in EZ-Member.
- Assist Membership Unit Director with any special project or task as assigned.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Minimum Experience:
- 3 to 4 years direct customer service experience.
- Direct sales or related experience preferably in the Managed Care industry.
- High school diploma or general education degree (GED).
- Basic knowledge of Medi-Cal and Medicare Advantage Prescription Drug Plans.
- Basic Computer Skills, 40 WPM (Microsoft Outlook, excel, word)
- 10-Key by Touch
- Direct handling and processing of CMS enrollments and disenrollment applications.
- Bilingual (English/Spanish) is required.
- Must be familiar with CMS MMR and TRR files
- Language Skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports and correspondence.
- Mathematical Skills: Ability to add and subtract two digit numbers and to multiply and divide with 10’s and 100’s. Ability to perform these operations using units of American money and weight measurement, volume, and distance.
- Reasoning Skills: Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions.
- Excellent communication skills, oral and written.
- Work Environment
- The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- The noise level in the work environment is usually moderate.
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.
- The employee is frequently required to walk; stand; reach with hands and arms.
- The employee is occasionally required to climb or balance and stoop, kneel, crouch, or crawl.
- The employee must occasionally lift and/or move up to 25 pounds.
- Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
Location City: Orange
Location State: California
Community / Marketing Title: Coordination of Benefit Representative
Who is Alignment Healthcare?
- Socially responsible
- Technologically enabled
- Concierge care
- Servant leadership
We are dedicated to transforming the complex and confusing process of medical treatment in the United States so that every link in the health care continuum becomes more efficient, productive, and effective. We built a team of people who want to make a difference. Come join the team that is changing health care one person at a time.
We believe that great work comes from people who are inspired to be their best. We invite you to explore our wide variety of roles based on your unique experience.