Payment Integrity Analyst – Coordination of Benefits

Role Overview

• Investigate and validate other insurance coverage, resolving conflicting eligibility information.
• Establish the correct order of liability (primary vs. secondary payer) to prevent and recover improper claim payments.
• Perform hands-on casework in a high-volume environment including outreach, documentation, and system updates.
• Apply analytical skills to interpret claims and eligibility data, identify trends, and recommend process improvements for COB program.

Requirements

• Bachelor’s Degree and/or one (1) year of related healthcare experience (e.g., COB/TPL, eligibility, claims operations, billing, recovery, or payment integrity).
• Minimum of one (1) year of experience performing COB investigations and/or payment integrity casework, including independent ownership of moderate-to-complex inventories.
• Minimum of one (1) year of experience performing data analytics with large data sets.
• Minimum of one (1) year of experience using working knowledge of coordination of benefits rules, primary/secondary payer logic, coverage hierarchy, and order-of-liability concepts; understanding of CMS and NAIC guidance as applicable.
• Comfortable navigating multiple systems, portals, and payer interfaces.
• Ability to maintain confidentiality and comply with HIPAA and data security standards.