Payment Accuracy Specialist (Coordination of Benefits)

Join our dynamic team as a Payment Accuracy, Coordination of Benefits (COB) Specialist within the Coordination of Benefits Business Unit (BU). You will play a crucial role in ensuring accurate payment processes and uncovering valuable insights for our clients.

A COB Specialist is responsible for reviewing and analyzing claims, member, and group data to identify instances of recoverable claims for the benefit of Cotiviti and our clients. Under direct supervision, this individual will be responsible for establishing the correct order of liability for our clients' members. This individual will also be responsible for inputting accurate claim recovery information in the proprietary Cotiviti software tools, as well as assisting with related inquiries throughout the claim recovery process.

You will receive direct supervision and guidance to enhance your efficiency and quality in handling assigned tasks, fostering professional growth.
• Demonstrates a strong ability to proactively develop and uphold a solid grasp of Centers for Medicare and Medicaid Services (CMS) and National Association of Insurance Commissioners (NAIC) guidelines to accurately determine liability order.
• Utilize state-of-the-art Cotiviti audit tools like the Recovery Management System (RMS), COB Tracker, and specialized client systems for comprehensive member investigations.
• Creates detail-oriented, accurate notes in Cotiviti audit tools and/or client tools throughout the member investigation.
• Meets or exceeds standards of production and quality as identified by compliance and regulatory guidelines and set forth by the Team Lead and/or Manager when reviewing concept and claim identifications for the client.
• Prepares and evaluates responses to client disputes both internally and externally within the Business Unit as needed.
• Identify and solve problems by classifying errors and overpayments for our healthcare clients.
• Identifies opportunities for continuous improvement for efficiencies within reporting and streamlining research processes.
• Demonstrates understanding of Cotiviti policies & procedures, and external regulatory requirements and performs duties in accordance with such regulatory requirements.
• Has a basic understanding of the healthcare industry, as well as proven track record of delivering results.
• Assures confidentiality and security of all data, adhering to all HIPAA (Health Insurance Portability and Accountability) laws and requirements. Demonstrates the skills, knowledge, and ability to ensure that our environment is safe, complying with industry standards.
• Has ability to take responsibility for outcome, whether positive or negative and apply learning as applicable.
• Integrates information from various sources and considers broader context.
• Tries unique ways of doing things and tests promising ideas.
• Actively seeks information to understand rationale.
• Complete all responsibilities as outlined on annual Performance Plan.
• Complete all special projects and other duties as assigned.
• Must be able to perform duties with or without reasonable accommodation.

• Minimum Requirement: High School Diploma.
• Bachelor's degree (Preferred) and/or a minimum of at least one (1) year related experience in healthcare.
• At least 1-year Cotiviti experience is recommended for individuals seeking their next opportunity internally. (Example: Retrieval Agent and/or Audit Support positions).
• Healthcare industry experience, including knowledge of Coordination of Benefits. (Preferred).
• Computer proficiency including Microsoft office (Word, Excel, Outlook).
• Excellent verbal and written communication skills.
• Strong interest in working with large data sets and various databases.
• Ability to work well in an individual and team environment demonstrating self-motivation to deliver success.
• Understands and embodies Cotiviti Core Values, Strategic Pillars, and Operations Disciplines to achieve successful performance in completing assigned responsibilities and interactions with the Organization both internally and externally.

Mental Requirements:

• Ability to analyze large volumes of data, identify trends, discrepancies, and anomalies. Must have exceptional attention to detail to ensure accuracy in financial records and audit findings.
• Demonstrates strong critical thinking skills, with the ability to assess complex situations, identify key issues, and propose practical solutions. Able to approach challenges methodically and with a strategic mindset.
• Makes informed decisions based on available data, regulations, and auditing standards. Must be able to weigh options and make recommendations that align with both compliance requirements and organizational goals.
• Strong understanding of auditing standards, regulations, and industry best practices. Must be able to apply these standards consistently to ensure accurate and compliant audit processes.
• Ability to recognize when something is wrong or needs further investigation. Must have the initiative to probe deeper into financial records or processes to uncover issues, inconsistencies, or irregularities.

Physical Requirements and Working Conditions:

• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.
• Must be able to provide a dedicated, secure work area.
• Must be able to provide high-speed internet access/connectivity and office setup and maintenance.
• No adverse environmental conditions expected.

Base compensation ranges from $20.00 per hour to $23.00 per hour. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. This role is eligible for discretionary bonus consideration.

Nonexempt employees are eligible to receive overtime pay for hours worked in excess of 40 hours in a given week, or as otherwise required by applicable state law.

Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.

Date of posting: 4/17/25
Applications are assessed on a rolling basis. We anticipate that the application window will close on 5/17/25, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.

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