Jobs
>
Grand Prairie

    eCOB Specialist III - Grand Prairie, United States - Elevance Health

    Elevance Health
    Elevance Health Grand Prairie, United States

    2 weeks ago

    Default job background
    Description
    Coordination of Benefits Specialist III

    Schedule:

    1-2 days per week in the office (Hybrid 1)

    Location:
    This position will work on a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.
    The

    Coordination of Benefits Specialist III

    is responsible for researching and investigating other coverage for all of the company's groups and member on multiple platforms. Fully proficient in all key areas; performs multi complex functions and interprets complex rules, laws and contracts. Accountable for end-to-end functionality on every Coordination of Benefits(COB) function including reconciliation of claim, membership and accounting.

    This is how will you make an impact:

    Utilizes internal queries, internal resource tools, must initiate delicate-in-nature phone calls to other carriers, members, groups, providers, attorneys, CMS and Medicaid and report to identify members who are or should be enrolled in other coverage.

    Aides members in enrolling in Medicare when they are entitled.

    Determines primacy on each case using a complex set of Primacy Rules as mandated by State and Federal Laws, such as CMS Primacy and NAIC rules and comparing them against the member/group Benefits.

    Updates all of the company's membership system components with investigation results for claim coordination.
    Ensures correct forms are provided to assist members enrolling in Medicare.
    Reviews claim history to identify claims requiring reconciliation, whether processed or pended, as well as recovered in error.

    Associate must identify the correct formulas in order to adjudicates impacted claims, using multiple COB Formulas for the various product types, pursuant to State and Federal Guidelines.

    Handles complex case research and resolution.
    May assist with training of new associates.

    Minimum Requirements:


    Requires a HS diploma or equivalent and a minimum of 3 years of claims processing and customer service and 3 years COB experience that required using NAIC & CMS COB guidelines; or any combination of education and experience which would provide an equivalent background.


    Preferred Skills, Capabilities, and Experiences:
    Medicaid WGS experience strongly preferred

    #J-18808-Ljbffr
  • Elevance Health

    eCOB Specialist III

    2 weeks ago

    Elevance Health Grand Prairie, United States

    Anticipated End Date: · Position Title: · eCOB Specialist III · Job Description: · Coordination of Benefits Specialist III · Schedule: 1-2 days per week in the office (Hybrid 1) · Location: This position will work on a hybrid model (remote and office). The ideal candidate ...

  • Southwire Company LLC

    Commission & Field Service Specialist Iii

    4 days ago

    Southwire Company LLC Carrollton, United States

    A leader in technology and innovation, Southwire Company, LLC is one of North America's largest wire and cable producers. Southwire and its subsidiaries manufacture building wire and cable, metal-clad cable, portable and electronic cord products, OEM wire products and engineered ...

  • Fort Worth Independent School District

    Specialist III

    1 week ago

    Fort Worth Independent School District Fort Worth, United States

    Position Type: · Leading District Professional/Specialist · Date Posted: · 5/2/2024 · Location: · VISUAL & PERFORMING ARTS · Closing Date: · 05/16/2024Specialist III - Instrumental Music - Band (Halftime Position) · Reports to: Director II - Instrumental Music · PC# · Pay Grade ...

  • Mechdyne

    On-Site Technical Support Specialist III

    5 days ago

    Mechdyne Irving, United States

    **On-Site Technical Support Specialist III** · ID # of Openings 1 Job Locations Irving, Texas Category Customer Service/Support **More information about this job:** · **Overview** · Mechdyne is one of the world's leading providers of innovative audio, visual, and information t ...

  • Dallas Independent School District

    Specialist III Applications

    1 week ago

    Dallas Independent School District Dallas, United States

    Job Description - Specialist III Applications (226 Days) (RTP Job DescriptionSpecialist III Applications (226 Days) - ( RTP DescriptionAssist in creating, testing, and distributing order configurations for holidays and special dates as needed Conduct upgrade testing for our FCNS ...

  • AmTrust Financial

    Claims Specialist III

    1 week ago

    AmTrust Financial Dallas, United States

    Claims Specialist III - Construction Defect · Job Locations · US-United States · Requisition ID · Category · Claims - Specialty Lines · Position Type · Regular Full-Time · Overview · Amtrust Financial Services, a fast growing commercial insurance company, is seeking a Co ...

  • Simmons Bank

    Compliance Specialist III

    3 weeks ago

    Simmons Bank Fort Worth, United States

    The Compliance Specialist III works directly with Director of Compliance within the area of Regulatory and Consumer Affairs. As the first line liaison and subject matter expert for business units, the Compliance Specialist III provides regulatory gui Compliance Specialist, Specia ...

  • Simmons Bank

    Compliance Specialist III

    3 weeks ago

    Simmons Bank Fort Worth, United States

    It's fun to work in a company where people truly BELIEVE in what they're doing · We're committed to bringing passion and customer focus to the business. · Position Summary · The Compliance Specialist III works directly with Director of Compliance within the area of Regulatory ...

  • Dallas Independent School District

    Specialist III Applications

    3 days ago

    Dallas Independent School District Dallas, United States

    · Assist in creating, testing, and distributing order configurations for holidays and special dates as needed · •Conduct upgrade testing for our FCNS enterprise software · •Assist in documenting and creating software cases to our enterprise software vendor · •Assist in all or ...

  • Texas Department of Aging & Disability Services

    Program Specialist III

    3 weeks ago

    Texas Department of Aging & Disability Services Fort Worth, United States

    Job Description: · Program Specialist III · The Disaster Preparedness and Business Continuity Team reports to the Director of Business Operations within the office of the Deputy Executive Commissioner within Access and Eligibility Services. This position will perform administrati ...

  • Texas State Gov

    Maintenance Specialist III

    5 days ago

    Texas State Gov Rowlett, United States

    Texas State Gov - JobID: [Field Technician / Maintenance Mechanic] As a Maintenance Specialist at the State of Texas, you'll: Clean ditches, culverts, stormwater ditches and drains; Dig up and repair broken pipes; Maintain, place and remove street signs and barricades; Assist in ...

  • Mary Kay

    Sourcing Specialist III

    6 hours ago

    Mary Kay Lewisville, United States

    Job Summary: · Working without appreciable direction, supports the Purchasing Division as a procurement expert that manages the categories of purchasing raw materials/ingredients. Identifies cost savings opportunities within assigned categories. May provide expertise to lower le ...

  • Frontier Communications

    NOC Specialist III – VoIP

    3 weeks ago

    Frontier Communications Dallas, United States

    Description · NOC Specialist III – VoIP · At Frontier, seeing what's beyond the horizon is in our fiber. And we've been doing just that for over 80 years – connecting communities with emerging communications technology across the country. At Frontier, we're transforming our bu ...

  • University of Texas at Dallas

    Child Development Specialist III

    15 hours ago

    University of Texas at Dallas Dallas, United States

    Posting Details · Posting Details · Posting Number · S05688P · Position Title · Child Development Specialist III - Infant/Toddler · Functional Title · Child Development Specialist III - Infant/Toddler · Department · Callier Ctr Communication · Salary Range · $43,000 - $45,0 ...

  • AmTrust Financial

    Loss Control Specialist III

    3 weeks ago

    AmTrust Financial Dallas, United States

    Loss Control Specialist III · Job Locations · US-United States · Requisition ID · Category · Underwriting · Position Type · Regular Full-Time · Overview · Seeking a multi-line proficient loss control professional to: · Provide consultative services to Managing General Ag ...

  • University of Texas at Dallas

    Child Development Specialist III

    3 weeks ago

    University of Texas at Dallas Dallas, United States

    Posting Details · Posting Details · Posting Number · S05384P · Position Title · Child Development Specialist III - Infant/Toddler · Functional Title · Department · Callier Ctr Communication · Salary Range · $43,000 - $45,000 · Pay Basis · Monthly · Position Status · Regul ...

  • University of Texas at Dallas

    Child Development Specialist III

    2 weeks ago

    University of Texas at Dallas Dallas, United States

    Posting Details · Posting Details · Posting Number · S05648P · Position Title · Child Development Specialist III - Preschool · Functional Title · Department · Callier Ctr Communication · Salary Range · $41,700 - $45,200, DOQ · Pay Basis · Monthly · Position Status · Regul ...

  • Dallas Independent School District

    Maintenance Specialist III, Concrete

    1 week ago

    Dallas Independent School District Dallas, United States

    Position Summary: · Under general supervision, perform all duties associated with site preparation, pouring concrete, and laying down asphalt to conform to acceptable construction standards. · * Perform all tasks related to concrete and asphalt installation and repair with minima ...

  • Dallas Independent School District

    Maintenance Specialist III, Concrete

    3 weeks ago

    Dallas Independent School District Dallas, United States

    Under general supervision, perform all duties associated with site preparation, pouring concrete, and laying down asphalt to conform to acceptable construction standards. Perform all tasks related to concrete and asphalt installation and repair with Maintenance Specialist, Concre ...

  • The University of Texas at Dallas

    Child Development Specialist III

    3 weeks ago

    The University of Texas at Dallas Dallas, United States

    Posting Number: S05648P · Department: Callier Ctr Communication · Salary Range: $41,700 - $45,200, DOQ · Pay Basis: Monthly · Position Status: Regular full-time · Location: Dallas · Job Description: · Looking for a rewarding opportunity to work with children? Join our Callier Cen ...