<p>This position is responsible for the overall Coordination of Benefits (COB) process within the Payment Integrity department. This includes ensuring that the member's enrollment records accurately reflect their primary/secondary coverage, leading to correct claims payment. This position investigates and resolves via outbound calls to other insurers, and CMS, as well as vendor partners and providers about COB leads generated from internal and external sources while meeting or exceeding designated quality standards. Identifies areas of improvement and works closely with interdepartmental teams around system enhancements. Reports upon COB metrics, as assigned. The COB Representative must have a comprehensive understanding of various regulations as related to COB and must complete all duties with strict regard to policies and procedures.</p> <p>Duties and Responsibilities:</p> <p>Responsibilities include, but are not limited to the following:</p> <ul> <li>Act as COB Operations Subject Matter Expert (SME) in the documentation and communication of department policies and procedures </li><li>Continuously monitor and update all COB-related operations documentation </li><li>Works closely with other carriers, including Commercial payers, and CMS, as well as interdepartmental staff in Claims and Member Services to ensure the accuracy of COB coverage </li><li>Works directly with the department's management team and staff to ensure all documentation is accurate and easy to understand </li><li>Work with line-level staff specialists and analysts to help streamline procedures and guidelines to improve operational efficiency </li><li>Provides timely feedback to leadership regarding claims documentation opportunities for improvement and successes </li><li>Other duties as assigned </li><li>Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood's Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents </li></ul>