Coordination of Benefits Processor (Managed Care) Remote

Molina Healthcare is hiring for Coordination of Benefits Processor. This role is remote and can be worked from a variety of locations. PST Time Zone is preferred.

This role will provide support for coordination of benefits review activities that directly impact medical expenses and premium reimbursement. Responsible for primarily coordinating benefits with other carriers responsible for payment. Facilitates administrative support, data entry, and accurate maintenance of other insurance records.

Highly Qualified Candidates Will Have the Following Experience-

• Healthcare Experience
• Administrative healthcare experience
• Solid experience with the MS Office Suite
• High attention to detail
• Solid work history

Essential Job Duties

• Supports multiple Lines of Business (LOBs), including Medicare and Marketplace (MKP)
• Validates external medical and pharmacy coverage through provider portals, outbound calls, and review of Explanation of Benefits (EOBs) to identify and verify other insurance information.
• Researches and validates state, vendor, and internal Coordination of Benefits (COB) leads through insurance carrier outreach and online resources.
• Reviews and interprets EOBs, medical claims, and eligibility information to determine appropriate COB actions.
• Processes provider disputes and submits claim adjustments to ensure claims are paid correctly based on validated COB information.
• Maintains Internal databases and other insurance records to ensure accurate member coverage information.
• Submits ECRS requests to CMS to update external coverage information within the CMS system.
• Maintains compliance with departmental procedures, documentation standards, and regulatory requirements related to COB and Medicare coordination.
• Provides telephone, administrative and data entry support for the coordination of benefits (COB) team.
• Phones or utilizes other insurance company portals to validate state, vendor and internal COB leads.
• Updates the other insurance table on the claims transactional system and COB tracking database.
• Contacts Centers for Medicare and Medicaid Services (CMS) directly, or coordinates with the assigned company contact to log tickets for premium restoration such as Medicare Secondary Payer (MSP) and End-Stage Renal Disease (ESRD). Job Requirements
• At least 1 year of administrative support experience, or equivalent combination of relevant education and experience.
• Customer service skills.
• Attention to detail, organizational and time-management skills; ability to manage simultaneous projects and tasks to meet internal deadlines.
• Ability to work cross-collaboratively across a highly matrixed organization and establish and maintain effective relationships with internal and external stakeholders.
• Effective verbal and written communication skills.
• Microsoft Office suite and applicable software programs proficiency. Preferred Qualifications• Health care experience.

To all current Molina employees. If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Same Posting Description for Internal and External Candidates