Navitus Health Solutions · 2 days ago

Product Manager, Coordination of Benefits

Appleton, WI

Full-time

Remote

Senior Level

5+ years exp

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Responsibilities

Manages coordination of benefits (COB) day-to-day work including coordinating and monitoring TPL, OHI files process, ensuring accurate reporting, meeting performance guarantees, initiating calls to gather COB data, and pursuing COB recoveries.

Serves as the subject matter expert for COB program questions, system enhancements, COB RFP questions, and new client implementations involving COB.

Remains current with changing regulatory and industry COB requirements to ensure compliance.

Leads and participates in applicable NCPDP COB task groups, meets with key personnel in other departments to understand COB needs, and makes recommendations for solutions.

Regularly audits and tests COB operational processes, creates and maintains COB policies, procedures, workflow, and training.

Qualification

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Managed CareHealth InsuranceMedicareMedicaidCommercial Claims ProcessingCOBThird-Party RecoveriesClaims ProcessingAutomated Claims EnvironmentProduct ManagementProgram ManagementNational Association of Insurance Commissioners (NAIC)HIPAAData Privacy PracticesCompliance ProgramHealthcare Industry PracticesProblem-SolvingInterpersonal CommunicationPharmacy Claims ProcessingKnowledge ManagementCommunication

Required

College degree or equivalent experience required in managed care or health insurance

Minimum of five years’ experience with Medicare, Medicaid and Commercial claims processing, COB and third-party recoveries in an automated claims environment required

Minimum of five years’ experience managing a product or program in the managed care or healthcare industry

Knowledge of National Association of Insurance Commissioners (NAIC), healthcare industry practices, HIPAA, and applicable data privacy practices required

Participate in, adhere to, and support compliance program objectives

The ability to consistently interact cooperatively and respectfully with other employees

Preferred

Pharmacy claims processing experience highly desirable; or equivalent combination of health insurance and/or managed care claims processing which would provide the required knowledge, skills, and abilities