Resp & Qualifications

PURPOSE: 
The Representative, MSP COB I focus on Medicare Secondary Payer (MSP) claims, Coordination of Benefits (COB) Claims or both. Investigates Medicare Secondary Payer and/or COB cases to resolve quickly.  Investigate and analyze Medicare Secondary Payer demands for coordination of benefits with Medicare.  Update/maintain accurate file information regarding OPL to ensure correct coordination occurs with Medicare.  Review case to determine primary liability.  Researches claims history in order to identify previously paid claims.  Determines liability based on timely filing guidelines and contractual benefits.  Responds to Department of Treasury and various collection agencies both written and verbally.

ESSENTIAL FUNCTIONS:

• Ensure requirements are followed for Medicare Secondary Payer. Investigate and analyze MSP reports for COB w/Medicare. Maintain Enrollment and OPL file information to ensure correct coordination with Medicare and other commercial insurance carriers.
  
  
  
• Identify and research information from internal and external sources regarding other employee group health insurance coverage to determine primary and secondary responsibility, following National Association of Insurance Commission guidelines and contract limitations. Review and update automated systems with accurate other insurance coverage information in a timely manner to facilitate proper adjudication of claims.
  Communicate with other insurance companies to ensure correct coordination of benefits and accurate claims processing. Create and send correspondence to members in order to determine correct coordination of benefits.
  
  
  
  
• Identifying claims previously paid as primary and secondary as well as those not previously processed. Researches claims history in order to identify previously paid claims. Adjusts claims as necessary once research is completed. Determines liability based on timely filing guidelines and contractual benefits. Position will manage the enrollment and COB/MSP adjustment while continuously recommending areas of improvement as the case is being analyzed and evaluated. Resolve COB/MSP inquiries and complete a full coordination of benefits review.
  
  
  

QUALIFICATIONS:

Education Level: High School Diploma or GED.

Experience: 3 years experience in claims, enrollment and billing, customer service or Other Party Liability.

Preferred Qualifications: CareFirst experience preferred. 

Knowledge, Skills and Abilities (KSAs)

• Attention to detail and excellent analytical and problem-solving skills.
• Must have strong written and verbal communication skills including organizational skills and the ability to set priorities and handle multiple projects concurrently.
• Extensive PC skills including Microsoft office software (i.e. Word and Excel) are necessary.

Salary Range: $35,640 - $65,340

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

Large Group Coordination of Be

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship.

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