A Payment Accuracy, Coordination of Benefits (COB) Specialist 2, is a member of the greater Coordination of Benefits Business Unit (BU). Coordination of Benefits involves situations in which an individual is covered by two or more health plans.

The Payment Accuracy, Coordination of Benefits (COB) Specialist 2 position requires expertise in auditing advanced data, conducting quality checks, exports, appeals, competitive intelligence, etc. This role involves demonstrating outcomes for multiple clients and enhancing processes for Cotiviti and clients. This position will have responsibility for moderate to more complex audit projects, executed with a high degree of autonomy for independent thinking and responsibility.

• Collaborates with various business levels on assigned projects and deliverables.
• Shares expertise as a Subject Matter Expert (SME) with Specialists and Specialist 1’s to enhance their role experience.
• Introduces new ideas, research, and creative thinking to drive innovation.
• Operates with the distribution of inventory and isolation to designate and distribute filters, queries, and/or call assignments to team members.
• Working with multi–clients to produce impact and outcomes, this individual will have advanced auditing skills as well as the ability to perform quality checks, export, appeals, comp intel, etc.
• Demonstrates a deep understanding of Centers for Medicare and Medicaid Services (CMS) and National Association of Insurance Commissioners (NAIC) guidelines to determine liability order accurately.
• Independently selects members using Cotiviti tools, with a comprehensive grasp of client parameters.
• Demonstrates advanced level of understanding of query and filter construction to identify opportunities.
• Uses Cotiviti audit tools such as Recovery Management System (RMS), COB Tracker, and specific client systems for member investigations.
• Maintains detailed and accurate notes in Cotiviti audit tools and/or client tools during member investigations.
• Meets or exceeds production and quality standards as per compliance regulations and guidelines, under the supervision of the Team Lead and/or Manager during client claim reviews.
• Prepares and assesses responses to client disputes internally and externally within the Business Unit when required.
• Identifies errors and overpayments for healthcare clients. Identifies opportunities for continuous improvement in reporting efficiencies and research processes.
• Has an in depth understanding of Cotiviti policies & procedures, and external regulatory requirements and performs duties in accordance with such regulatory requirements.
• Possesses advanced knowledge of the healthcare industry and a demonstrated history of achieving results.
• Ensures data confidentiality and security, complying with HIPAA laws and requirements. Demonstrates the ability to maintain a safe environment in line with industry standards.
• Has ability to take responsibility for outcome, whether positive or negative and apply learning as applicable
• Integrates information from diverse sources and evaluates within a broader context.
• Drives innovation to improve operational efficiency and discover new approaches to meet work requirements.
• Proactively seeks information to comprehend reasoning and deliver exceptional results exceeding basic standards.

• High School Diploma Required; Bachelor’s degree is preferred, along with a minimum of 2-4 years of relevant healthcare experience.
• A minimum of 1-2 years of Cotiviti experience is advised for internal candidates, such as those in current COB Specialist 1 and/or Payment Accuracy Specialist 2 roles.
• Must have experience in the healthcare industry, including understanding of Coordination of Benefits.
• Proficient in Microsoft Office applications (Word, Excel, Outlook).
• Strong verbal and written communication skills required.
• Keen interest in handling large data sets and diverse databases.
• Able to work effectively both independently and in a team, showing self-motivation for successful outcomes.

Mental Requirements:

• Communicating with others to exchange information.
• Assessing the accuracy, neatness, and thoroughness of the work assigned.

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 $26 to $29. 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.

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: 5/28/2025
Applications are assessed on a rolling basis. We anticipate that the application window will close on 6/28/2025, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.