Claims Coordination of Benefits Analyst

Job Summary

A company is looking for a Claims Coordination of Benefits (COB) Analyst.

Key Responsibilities:

• Conduct in-depth COB analysis to prevent and recover incorrect payments
• Apply CMS, NAIC, ERISA, and Medicare Secondary Payer (MSP) rules to determine primary/secondary liability
• Collaborate with Payment Integrity and SIU teams to resolve claims flagged for COB issues or FWA risk

Qualifications:

• 3-5+ years in COB analysis, claims operations, or payment integrity at a health plan or TPA
• Experience with pre-pay and post-pay integrity controls, audit response, and provider recovery
• Familiarity with claims platforms such as HealthEdge, Facets, or QNXT
• Strong knowledge of federal and state regulations affecting COB and improper payment recovery