What are the responsibilities and job description for the Coordination of Benefits (COB) Analyst - Jefferson Health Plan position at Jefferson Health?
Job Details
The Coordination of Benefits (COB) Analyst is responsible for identifying, investigating, and resolving potential third-party liability and overlapping insurance coverage. This role supports accurate claims payment by determining the correct order of benefits between payers, updating COB records, and initiating claim rework when appropriate. The position involves moderate to complex COB investigations requiring independent judgment, analytical skills, and consistent application of regulatory and operational guidelines.
Job Description
Workday Day (United States of America)
Worker Sub Type
Regular
Employee Entity
Health Partners Plans, Inc.
Primary Location Address
901 Market Street, Philadelphia, Pennsylvania, United States of America
Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200 undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.
Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.
Benefits
Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.
For more benefits information, please click here
The Coordination of Benefits (COB) Analyst is responsible for identifying, investigating, and resolving potential third-party liability and overlapping insurance coverage. This role supports accurate claims payment by determining the correct order of benefits between payers, updating COB records, and initiating claim rework when appropriate. The position involves moderate to complex COB investigations requiring independent judgment, analytical skills, and consistent application of regulatory and operational guidelines.
Job Description
- Conducts outbound and inbound outreach, as needed, to members, providers, employers, or other insurers to obtain, validate, or clarify other insurance. coverage information in support of COB determinations. Reviews member eligibility and coverage information to identify overlapping insurance coverage.
- Determines the correct order of benefits between payers in accordance with CMS Medicare Secondary Payer (MSP) rules and NAIC commercial Coordination of Benefits guidelines.
- Performs moderate to complex COB investigations involving multiple coverages, conflicting data, or overlapping eligibility periods. Accurately updates COB and coverage records in core systems to support proper claims routing and adjudication. Initiates claim reprocessing, cost avoidance, or recovery actions when COB determinations impact previously processed claims.
- Responds to COB-related claim appeals, inquiries, and research requests by reviewing coverage determinations and supporting documentation.
- Documents investigation findings clearly and thoroughly while meeting established productivity, quality, and timeliness standards.
- High School Diploma/GED with relevant experience required
- 2 years of experience in healthcare insurance operations, such as COB, TPL, claims processing, enrollment, or payment integrity required
- Associate’s Degree in healthcare related field or Bachelor’s Degree in healthcare related field preferred
Workday Day (United States of America)
Worker Sub Type
Regular
Employee Entity
Health Partners Plans, Inc.
Primary Location Address
901 Market Street, Philadelphia, Pennsylvania, United States of America
Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200 undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.
Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.
Benefits
Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.
For more benefits information, please click here