Supervisor COB and Recovery

<strong>At Emergent Holdings, we&rsquo;re creating an innovative environment where our employees belong authentically, contribute meaningfully, and thrive intentionally &mdash; both personally and professionally.</strong>

Southfield, USA

Emergent Holdings

<p class="p1"><strong>Emergent Holdings is driven by a singular goal &mdash; improving the health and safety of our customers and our communities. How do we do that? We create innovative insurance products, technology solutions, and services to support our key stakeholders &mdash; individuals, employers, providers, and strategic partners &mdash; improving the health and safety of the people and places we serve.</strong></p>

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Competitive Compensation and Benefits Package

Overview: <br />Responsible for supporting and providing oversight of all activities related to coordination of benefits (COB) servicing and recovery activities.&nbsp;This position will supervise and support team members and act as a liaison between MA operational areas and corporate business areas, and lead group or committee discussions related to COB and recovery. This position will serve as the lead for issue resolution, verification, research, analysis, tracking, and reporting of COB functions including COB servicing and recovery initiatives. This position reports to the Manager, COB and Recoveries.<br /><br /> <p><strong>WORKING CONDITIONS:</strong></p> <p>Work is performed in an office setting with no unusual hazards. Some travel may be required. May be required to lift and carry items weighing up to 35 lbs.</p>
Responsibilities: <br /> <ul> <li>Supervises COB servicing, verification, claim recovery identification, and recovery collection efforts.</li> <li>Maintains quality and performance thresholds for COB and recovery processes</li> <li>Ensures data validation, control measures, and reconciliation activities are executed and reviews results with team members.&nbsp; &nbsp;</li> <li>Initiates and implements changes to improve processes and meet requirements. Partners with leadership and colleagues to ensure expected outcomes are achieved.&nbsp;</li> <li>Supports vendor invoice reconciliation efforts.</li> <li>Leads vendor oversight and operations for contracted COB and recovery services.</li> <li>Hires, supervises, coaches, mentors, and develops team members.</li> <li>Leads the implementation of COB and recovery initiatives.</li> <li>Collaborates and communicates with Medicare operational leaders, vendors, and support areas on COB servicing and recovery initiatives.</li> <li>Monitors, tracks, and reports COB servicing and recovery outcomes.</li> <li>Understands and applies&nbsp;CMS guidance with respect to MA program and Part D plan sponsors as it relates to COB and recovery,&nbsp;Medicare Secondary Payer provisions, and applicable MA and Part D federal regulations.</li> <li>Lead complex projects with cross-functional teams</li> </ul> <br /> <p><strong>DIRECTION EXERCISED:</strong></p> <ul> <li>Directly supervises exempt staff in accordance with company policies and applicable Federal and State Laws.&nbsp;</li> <li>Responsibilities include but are not limited to effectively interviewing, hiring, terminating, and training employees; planning, assigning and directing work; appraising performance; rewarding and counseling employees; addressing complaints and resolving problems; supporting and encouraging the engagement process.</li> </ul>
Requirements: <br /> <p><strong>EDUCATION OR EQUIVALENT EXPERIENCE:</strong></p> <ul> <li>Bachelor&rsquo;s Degree in Business Administration or related field.</li> <li>Equivalent relevant combination of education and experience may be considered in lieu of degree.</li> <li>Certification or progress toward certification is highly preferred and encouraged.</li> </ul> <br /> <p><strong>EXPERIENCE:</strong></p> <ul> <li>Five years of work experience in a Medicare Advantage Plan, managed care environment, CMS payer role, COB/claim recovery vendor, healthcare operations or as a consultant providing COB/claim recovery analysis to managed care organizations.</li> <li>A minimum of one year demonstrated leadership experience is required.</li> <li>Experience with MSP verification, claim recovery identification, recovery collection, and/or reconciliation.</li> <li>Prior experience with vendor relations.</li> <li>Prior experience managing multiple workflows and measuring performance outcomes.</li> <li>Medicare Advantage plan operation experience is preferred.</li> <li>Leading and facilitating cross-functional work groups or committees.</li> <li>Experience analyzing and managing data for multiple work streams</li> <li>iKA claims system experience is desired.&nbsp;</li> <li>Prior experience supervising direct reports is preferred.&nbsp;</li> <li>Prior Part C/D COB experience preferred.</li> <li>Experience posting and reconciling claim refunds is preferred.</li> <li>Experience with Microsoft Access using queries, import/export, and form view for workflow is desired.</li> <li>Experience analyzing data and managing multiple assignments is required.</li> </ul> <br /> <p><strong>SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:</strong></p> <ul> <li>Knowledge of&nbsp;CMS guidance with respect to MA program and Part D plan sponsors as it relates to COB and recovery,&nbsp;Medicare Secondary Payer provisions, and applicable MA and Part D federal regulations.</li> <li>Ability to manage and reconcile data for multiple work streams</li> <li>Ability to collaborate and reach an agreement with internal stakeholders</li> <li>Strong analytical and reporting skills with work experience</li> <li>Ability to monitor inventory, performance, and influence outcomes</li> <li>Ability to maintain quality thresholds and resolve root cause issues</li> <li>Excellent analytical, organizational, research, verbal and written communication skills.</li> <li>Ability to work effectively in a team environment.</li> <li>High level of proficiency in use of existing software packages (Access, Microsoft Word, Excel, Outlook, etc.).</li> <li>Ability to multi-task and prioritize work assignments.</li> <li>Ability to write in a clear, concise and grammatically correct manner and be able to translate complex requirements into language understandable by the general public.</li> </ul>