Carelon Coordination of Benefits (COB) - Investigator II (Internal Job Title: Financial Operations Recovery Specialist II) is responsible for conducting thorough investigations into potential other coverages, accurately determining primacy, and ensuring seamless coordination of benefits across multiple vendor clients, employer groups, and government and specialty lines of business. The role requires proficiency in multi-system data analysis, claims adjudication, and regulatory compliance, handling complex cases beyond automated systems. Responsibilities include conducting in-depth COB investigations using NAIC, CMS, MSP, ERISA, and other regulations; analyzing data sources such as COB Smart, HEW, claims, and membership data; navigating multiple client systems; managing communications with stakeholders; ensuring accuracy in membership data updates; applying client-specific COB methodologies; identifying and rectifying incorrectly paid claims; maintaining compliance with SLAs and guidelines; and performing additional duties to support vendor operations and client services. Minimum requirements include a high school diploma or equivalent and at least 2 years of claims processing and/or customer service experience. Preferred qualifications include 2 years of COB investigation experience, knowledge of Medicare Secondary Payer and other regulations, healthcare administration degree preferred, proficiency in Microsoft Office and claims processing software, negotiation and dispute resolution skills, ability to manage high-volume caseloads, strong team collaboration, and exceptional attention to detail.

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