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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.

Additional Information

+ Organization: HAP (Health Alliance Plan)

+ Department: Payment Integrity

+ Shift: Day Job

+ Union Code: Not Applicable

Additional Details

This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.

Overview

Henry Ford Health partners with millions of people on their health journey, across Michigan and around the world. We offer a full continuum of services – from primary and preventative care to complex and specialty care, health insurance, a full suite of home health offerings, virtual care, pharmacy, eye care and other health care retail. With former Ascension southeast Michigan and Flint region locations now part of our team, Henry Ford’s care is available in 13 hospitals and hundreds of ambulatory care locations. Based in Detroit, Henry Ford is one of the nation’s most respected academic medical centers and is leading the Future of Health: Detroit, a $3 billion investment anchored by a reimagined Henry Ford academic healthcare campus. Learn more at henryford.com/careers .

Benefits

The health and overall well-being of our team members is our priority. That’s why we offer support in the various components of our team’s well-being: physical, emotional, social, financial and spiritual. Our Total Rewards program includes competitive health plan options, with three consumer-driven health plans (CDHPs), a PPO plan and an HMO plan. Our team members enjoy a number of additional benefits, ranging from dental and eye care coverage to tuition assistance, family forming benefits, discounts to dozens of businesses and more. Employees classified as contingent status are not eligible for benefits.

Equal Employment Opportunity/Affirmative Action Employer

Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health 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.