Coordination of Benefits Specialist
3 days ago
Miami
Job Description Overview Tenavi Staffing is seeking a detail-oriented Coordination of Benefits Specialist I to support healthcare payer operations and ensure accurate member eligibility and claims coordination. This role plays a critical part in maintaining the integrity of Other Health Insurance (OHI) and Coordination of Benefits (COB) data across membership and claims systems. The ideal candidate brings strong experience working with Medicare eligibility, CMS files, claims research, and payer sequencing in a regulated healthcare environment. This position directly supports financial accuracy, claims processing efficiency, regulatory compliance, and member experience outcomes. Location: Doral, FL Employment Type: Full-Time Pay Rate: $19.00–$21.00/hour Industry: Healthcare Key Responsibilities • Research and validate other insurance coverage using CMS eligibility files, payer databases, and internal systems, • Maintain accurate COB and eligibility records to support correct claims adjudication and payer sequencing, • Analyze claims history to identify coordination issues, overpayments, and incorrect primary payer assignments, • Apply Medicare Secondary Payer (MSP) rules and CMS guidelines to determine accurate liability and coverage responsibility, • Reconcile eligibility, membership, and claims data across multiple systems to ensure data integrity, • Conduct outbound outreach to members, providers, employers, carriers, and government agencies to verify insurance coverage, • Update membership systems with verified COB findings and corrected coverage indicators, • Identify and resolve discrepancies tied to CMS enrollment data and eligibility records, • Support claims reprocessing, adjustments, and recovery efforts related to COB inaccuracies, • Document investigations, findings, outreach activity, and system updates in accordance with compliance and audit standards Required Qualifications • High School Diploma or GED required, • 3–5+ years of experience in healthcare claims, eligibility, Coordination of Benefits, or Medicare operations, • Strong understanding of Medicare Secondary Payer (MSP) rules and COB principles, • Experience working with CMS eligibility files, Medicare Advantage plans, or managed care organizations, • Ability to analyze claims data and determine correct payer responsibility, • Strong attention to detail with accurate documentation and data entry skills, • Experience navigating healthcare membership, claims, or eligibility systems, • Ability to manage multiple cases independently in a fast-paced environment Preferred Qualifications • Experience supporting Medicare Advantage or managed care health plans, • Knowledge of COB recovery and claims adjustment workflows, • Familiarity with CMS enrollment data and Medicare eligibility verification processes, • Experience working in regulated healthcare or payer environments, • Associate's or bachelor's degree in healthcare administration, Business, or related field preferred Tools & Systems • CMS eligibility and enrollment files, • Healthcare claims adjudication systems, • Membership and eligibility platforms, • Medicare Advantage systems, • COB and MSP workflows, • Microsoft Office Suite, including Excel, • Internal payer databases and external carrier verification tools What Success Looks Like • Accurate and timely resolution of COB investigations and eligibility discrepancies, • Improved claims adjudication accuracy and reduction in payer sequencing errors, • Consistent compliance with CMS, MSP, and HIPAA requirements, • Strong documentation quality and audit readiness across all investigations, • Effective collaboration with claims, eligibility, and recovery teams to resolve coordination issues WORKING CONDITIONS The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. • The noise level in the work environment is usually moderate., • Works in the field, • Interacts with patients, family members, staff, visitors, government agencies, etc., under a variety of conditions and circumstances. This work requires the following physical activities: climbing, bending, stooping, kneeling, reaching, sitting, standing, walking, lifting, finger dexterity, grasping, repetitive motions, talking, hearing and visual acuity. The work is performed indoors. Sits, stands, bends, lifts, and moves intermittently during working hours. May be sitting for a prolonged period. The work schedule is approximate, and hours/days may change based on company needs. All full-time employees are required to complete forty (40) hours per week as scheduled, including weekends and holidays as needed. May require some OT during varying seasons of the year. PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. The employee must be able to frequently lift up to 10 pounds and occasionally lift and/or move up to 25 pounds. While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to stand and walk. The employee is occasionally required to use hands to finger, handle, or feel; reach with hands and arms; climb or balance, and stoop, kneel, crouch, or crawl. Specific vision abilities required for this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus. Why Join • Opportunity to support critical healthcare payer operations that directly impact claims accuracy and member outcomes, • Collaborative environment focused on operational excellence and compliance, • Exposure to Medicare Advantage, CMS processes, and complex payer coordination workflows, • Stable healthcare environment with opportunities to expand payer operations expertise Interested in Learning More? Apply directly or reach out to discuss the opportunity in more detail.
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