COB Claims Specialist I

It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary:

The COB Claims Specialist I is responsible for accurately processing claims involving Coordination of Benefits (COB) to ensure proper payment and compliance with other insurance coverage rules. This entry-level position supports timely and efficient claims adjudication by applying COB rules. The specialist works closely with internal teams to resolve claim issues and contribute to overall operational effectiveness.

Our Investment in You:

·       Full-time remote work

·       Competitive salaries

·       Excellent benefits

Key Functions/Responsibilities:

• Update and maintain member coverage records in claims systems and COB databases
• Review and process Medicaid claims in accordance with COB protocols and applicable federal/state regulations.
• Communicate with healthcare providers to resolve claims processing inquiries
• Other duties as assigned

Supervision Exercised:

• None

Supervision Received:

• Close supervision received daily

Qualifications:  

Education Required:  

• High School Diploma (or equivalent/ GED)

Education Preferred:

Experience Required:

• Two (2) or more years of claims processing experience
• Two (2) or more years of health insurance experience, with an understanding of industry terminology

Experience Preferred/Desirable:

• Two (2) years of consecutive work experience
• One (1) year of Cognizant Claims Processing (Facets, QNXT)

Required Licensure, Certification or Conditions of Employment:

• None

Competencies, Skills, and Attributes:

• Working knowledge of Microsoft Office products.
• Demonstrated ability to navigate across various computer systems
• Ability to relate and communicate positively, effectively, and professionally.
• Basic oral and written communication skills, with the ability to clearly convey information and follow written instructions.
• Basic knowledge of health insurance industry
• Basic Understanding of health insurance COB rules, including Commercial, Medicaid, and Medicare guidelines
• Ability to work independently and as a member of a team.
• Detail oriented

Working Conditions and Physical Effort:

• Ability to work OT during peak periods.
• Regular and reliable attendance is an essential function of the position.
• Work is normally performed in a typical interior/office work environment.
• No or very limited physical effort required. No or very limited exposure to physical risk.

Compensation Range

$16.35 - $22.84

This range offers an estimate based on the minimum job qualifications.  However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer.  This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing.  

Note: This range is based on Boston-area data, and is subject to modification based on geographic location. 

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees