CSR (eCoordination of Benefits Spec I ) at Elevance Health

Taguig City, National Capital Region, Philippines

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Not SpecifiedCompensation

Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

HS diploma or equivalent
1 year of claims processing and/or customer service skills
1 year coordination of benefits experience (or any combination of education and experience providing equivalent background)
Knowledge of NAIC & CMS COB guidelines
Excellent oral and written communication skills
Skill in using PC, database system, and related software (word processing, spreadsheets, etc.)

Responsibilities

Researching and investigating other coverage for all of the company's groups and members
Performing multi-complex functions and interpreting complex rules, laws, and contracts
Handling end-to-end functionality on every Coordination of Benefits (COB) function, including reconciliation of claims, membership, and accounting
Utilizing internal queries, internal resource tools, and initiating delicate phone calls to other carriers, members, groups, providers, attorneys, CMS, and Medicaid to identify members who are or should be enrolled in other coverage
Aiding members in enrolling in Medicare when entitled
Updating all of the company's membership system components with investigation results for claim coordination
Ensuring correct forms are provided to assist members enrolling in Medicare
Reviewing claim history to reconcile processed, pended, or recovered claims with any errors
Identifying the correct formulas to adjudicate impacted claims using multiple COB formulas for various product types, pursuant to State and Federal guidelines

Skills

Coordination of Benefits

Claims Processing

Customer Service

NAIC Guidelines

CMS Guidelines

Claims Adjudication

Claims Reconciliation

Excel

Word Processing

Database Systems

Elevance Health

Integrated health services and digital platform

About Elevance Health

Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.

Indianapolis, IndianaHeadquarters

1944Year Founded

$309.4MTotal Funding

IPOCompany Stage

Enterprise Software, Social Impact, HealthcareIndustries

10,001+Employees

Benefits

Medical, dental, & vision insurance

401(k) + match

Paid holidays

Paid Time Off

Incentive bonus programs

Stock purchase plan

Life insurance

Wellness Programs

Financial education resources

Adoption & Surrogacy Assistance

Dependent-care Flexible Spending Account (DCFSA)

Parental Leave

Parental Transition Week

Critical Caregiving Leave

Risks

Departure of CFO John Gallina may create a gap in financial leadership.

Lawsuit against CMS over MA Star Ratings could lead to financial penalties.

CareBridge integration may face operational challenges, disrupting service delivery.

Differentiation

Elevance Health integrates whole health approach with digital health platform for comprehensive care.

Acquisition of CareBridge enhances home health services within Carelon division.

Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.

Upsides

AI integration in home health services can reduce hospital readmissions and improve outcomes.

Predictive analytics support early disease detection, aligning with Elevance's whole health approach.

Telehealth expansion offers opportunities to reach more patients remotely.

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