L.A. Care Health Plan Los Angeles , CA 90009
Posted 2 months ago
Salary Range: $50,216.00 (Min.) - $62,770.00 (Mid.) - $75,324.00 (Max.)
Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.
Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
Job Summary
The Coordination of Benefits (COB) Validation Specialist ensures the accurate coordination of healthcare benefits for individuals covered under multiple insurance plans. The role involves validating coordination of benefits data, identifying discrepancies, and resolving issues to optimize benefit utilization and minimize costs. The COB Validation Specialist collaborates closely with various stakeholders, including insurance carriers, healthcare providers, and clients to ensure seamless coordination of benefits processing. The COB Validation Specialist conducts outbound calls to members and health plan carriers to validate coordination of benefits information. The Specialist proactively identifies, documents, investigates, and resolves COB issues in a timely and appropriate manner.
Duties
Stakeholder Communication
Data Validation
Discrepancy Resolution
Quality Assurance
Perform other duties as assigned. (10%)
Duties Continued
Education Required
Associate's Degree
In lieu of degree, equivalent education and/or experience may be considered.
Education Preferred
Bachelor's Degree
Experience
Required:
1 year of experience in healthcare insurance coordination, claims processing, or data validation.
Experience in Customer Service.
Preferred:
3 years of office experience in Managed Health Care.
Skills
Required:
Solid understanding of standard claims processing, COB guidelines and data analysis.
Must have knowledge of HMO, PPO, EPO, POS, Government Funded, Medicare and Medicaid plans.
Ability to effectively prioritize and meet deadlines while managing multiple competing tasks.
Must have strong analytical skills.
Ability to work effectively with diverse team members and key internal and external stakeholders.
Excellent communication and interpersonal skills for effective collaboration with stakeholders at all levels.
Detail-oriented with a focus on accuracy and thorough documentation.
Ability to work independently and prioritize tasks in a fast-paced environment.
Proficient with Windows, Microsoft Office programs, and Outlook.
Preferred:
Must be familiar with coordinating benefits between health plan payers.
Knowledge of healthcare insurance regulations and coordination of benefits guidelines.
Licenses/Certifications Required
Licenses/Certifications Preferred
Required Training
Physical Requirements
Light
Additional Information
Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
L.A. Care offers a wide range of benefits including
Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)
Nearest Major Market: Los Angeles
Job Segment: Claims, Medicaid, Medicare, Compensation, HR, Insurance, Healthcare, Human Resources
L.A. Care Health Plan