Start or grow your health insurance career in a fully remote claims role. As a COB Claims Specialist I, you will focus on getting claims paid correctly the first time by applying Coordination of Benefits rules for members with more than one type of coverage.
About WellSense Health Plan
WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Medicaid, and Individual and Family plans. Founded as Boston Medical Center HealthNet Plan, WellSense is built around one core idea: health coverage should work for people, no matter their circumstances. The organization is committed to equity, inclusion, and making it easier for members to get the care they need.
Schedule
- Position Type: Full time, remote
- Work Setting: Home office, typical weekday schedule
- Environment: Computer based claims work with close daily supervision and support
- Overtime: Ability to work overtime during peak periods
- Attendance: Regular and reliable attendance required
What You’ll Do
- Update and maintain member coverage records in claims systems and COB databases.
- Review and process Medicaid claims in line with Coordination of Benefits rules and federal and state regulations.
- Apply COB guidelines for Commercial, Medicaid, and Medicare coverage to ensure accurate and compliant payments.
- Communicate with healthcare providers to resolve questions or issues about claim processing.
- Navigate across multiple computer systems and tools to research and resolve claim discrepancies.
- Support the claims team with additional tasks as assigned, contributing to timely and accurate adjudication.
What You Need
- High school diploma or equivalent (GED).
- At least 2 years of claims processing experience.
- At least 2 years of health insurance experience with a basic understanding of industry terminology.
- Preferred: 2 years of consecutive work history and 1 year of Cognizant claims processing experience (Facets or QNXT).
- Basic knowledge of health insurance COB rules for Commercial, Medicaid, and Medicare.
- Working knowledge of Microsoft Office products and comfort using multiple computer systems.
- Strong attention to detail, with the ability to follow written instructions and document work clearly.
- Positive, professional communication skills and the ability to work both independently and as part of a team.
- Willingness to work overtime during busy periods and maintain consistent, reliable attendance.
Benefits
- Full time remote position with competitive hourly pay in the range of 16.35 to 22.84 dollars, depending on experience and location.
- Medical, dental, vision, and pharmacy benefits.
- Paid time off, paid holidays, and merit increases.
- Flexible Spending Accounts and 403(b) savings plan with matches.
- Career growth opportunities inside a mission driven nonprofit health plan and resources to support employee and family wellbeing.
Remote claims roles with clear growth potential and solid benefits do not stay open long.
If you are detail oriented, dependable, and ready to build a long term career in health insurance from home, this is a strong place to begin.
Happy Hunting,
~Two Chicks…