COB Recovery Specialist (Hybrid/Troy, MI) - Health Alliance Plan
🔍 Troy, Michigan
GENERAL SUMMARY:
The COB Recovery Specialist plays a pivotal role in advancing Coordination of Benefits (COB) and Medicare Secondary Payer (MSP) recovery efforts by independently resolving complex coverage issues and workflow initiatives. The COB Recovery Specialist will be a self-starter with strong decision-making capabilities and a deep understanding of COB processes in a health plan environment. The COB Recovery Specialist ensures compliance with State law, Medicare Secondary Payer (MSP) rules, National Association of Insurance Commissioners (NAIC) guidelines, and internal policies and procedures.
PRINCIPLE DUTIES AND RESPONSIBILITIES:
- Apply specialized knowledge to independently resolve escalated or high-complexity COB cases, including disputes involving dual/multiple coverage determinations.
- Exercise discretion in interpreting CMS guidance and internal policy to make determinations on MSP recoverability, premium adjustments, and claim reimbursement strategies.
- Support and contribute to the Medicare Secondary Payer (MSP) demand and claims recovery process, ensuring appropriate coordination with providers, CMS, and internal finance or compliance teams.
- Monitor daily COB operations to ensure timeliness, accuracy, and adherence to standards; evaluate workflow bottlenecks and reassign work based on critical need.
- Provide direct training, mentoring, and guidance to junior staff, including developing and implementing procedural documentation.
- Coordinate and lead small to mid-scale projects focused on operational improvements, system enhancements, or regulatory compliance initiatives.
- Represent the department in cross-functional workgroups.
EDUCATION/EXPERIENCE REQUIRED:
- Associate’s degree (or equivalent combination of education and relevant experience). Bachelor’s degree in health administration, business, or related field preferred.
- At least four (4) years of experience in COB operations and investigations including researching and resolving Workers’ Comp, auto injuries, minor dependent overlap, and Medicare eligibility conflicts.
- Three (3) years of COB recordkeeping and documentation experience.
- One (1) year of experience in data analysis or report preparation.
- Minimum of four (4) years of experience in healthcare, medical billing, or insurance claims coordination preferred
- Minimum of four (4) years of experience making COB determinations with working knowledge of MSP, NAIC guidelines, and COB regulatory frameworkspreferred.
- Proficiency in Microsoft Office Suite (Word, Excel, Outlook), Power BI, and EDW preferred.
Skills and Abilities:
- Self-starter with strong decision-making capabilities and a deep understanding of COB processes in a health plan environment.
- Ability to independently resolve complex coverage issues.
- Strong verbal and written communication skills.
- Proven ability to manage multiple tasks and deadlines effectively in a fast-paced environment.
- Strong analytical, critical thinking, and problem-solving abilities.
- Detail-oriented with the ability to interpret eligibility and claims data accurately.
- Familiarity with basic medical terminology and healthcare coding a plus.
Overview
HAP is a Michigan-based, nonprofit health plan that provides health coverage to individuals, Â Â Â Â Â companies and organizations. A subsidiary of Henry Ford Health System, we partner with doctors, employers and community groups to enhance the overall health and well-being of the lives we touch. With more than 1,100 dedicated and passionate employees, our goal is to make health care easy for our members.
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Under the leadership of President and CEO Robert G. Riney, Henry Ford Health is a
$6 billion integrated health system comprised of six hospitals, a health plan, and 250+ sites
including medical centers, walk-in and urgent care clinics, pharmacy, eye care facilities and
other healthcare retail. Established in 1915 by auto industry pioneer Henry Ford, the health system
now has 32,000 employees and remains home to the 1,900-member Henry Ford Medical Group, one
of the nation’s oldest physician groups. An additional 2,200 physicians are also affiliated with the
health system through the Henry Ford Physician Network. Henry Ford is also one of the region’s Â
major academic medical centers, receiving between $90-$100 million in annual research funding and
remaining Michigan’s fourth largest NIH-funded institution. Also an active participant in medical
education and training, the health system has trained nearly 40% of physicians currently practicing
in the state and also provides education and training for other health professionals including nurses,
pharmacists, radiology and respiratory technicians. visit HenryFord.com.
Benefits
Whether it's offering a new medical option, helping you make healthier lifestyle choices or
making the employee enrollment selection experience easier, it's all about choice. Â Henry
Ford Health System has a new approach for its employee benefits program - My Choice
Rewards. Â My Choice Rewards is a program as diverse as the people it serves. Â There are
dozens of options for all of our employees including compensation, benefits, work/life balance
and learning - options that enhance your career and add value to your personal life. Â As an
employee you are provided access to Retirement Programs, an Employee Assistance Program
(Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness
and access to day care services at Bright Horizons Midtown Detroit, and a whole host of other
benefits and services. Employee's classified as contingent status are not eligible for benefits
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health System is
committed to the hiring, advancement and fair treatment of all individuals without regard to
race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,
weight, marital status, family status, gender identity, sexual orientation, and genetic information,
or any other protected status in accordance with applicable federal and state laws.