Member Financial Specialist – Eligibility & COB

Job Description

• This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Member Financial Specialist – Eligibility & COB based in United States. The Member Financial Specialist – Eligibility & COB plays a key role in supporting accurate financial operations and improving the member experience. This position focuses on resolving Coordination of Benefits (COB) denials, addressing eligibility challenges, and ensuring insurance information is accurate and up to date. You will collaborate with members, insurance carriers, and internal teams to resolve coverage discrepancies and support smoother claims processing. The role combines customer communication, data analysis, insurance expertise, and operational problem-solving in a mission-driven environment. You will help reduce financial barriers to care by guiding members through benefit questions and clarifying their responsibilities. This is an opportunity for a detail-oriented professional who enjoys making a meaningful impact while working in a dynamic and evolving healthcare setting.
• Accountabilities: Investigate and resolve Coordination of Benefits (COB) denials by working directly with insurance carriers and members to identify and correct coverage issues. Conduct outreach to members to collect, verify, and update insurance information while providing clear guidance on benefits, coverage, and next steps. Maintain accurate member account records by documenting verified insurance details, coverage changes, and financial responsibility updates. Review and process documentation related to coverage updates, COB forms, payer communications, and eligibility changes. Support initiatives related to contract updates, insurance transitions, and operational improvements. Analyze eligibility, coverage, and denial trends through routine and ad-hoc reporting to identify opportunities for process improvements. Interpret data reports and use insights to support targeted outreach and improve claims accuracy. Communicate professionally and empathetically with members and insurance organizations through phone, video, and written correspondence. Maintain strong knowledge of insurance policies, benefit structures, payer processes, and member financial responsibility guidelines. Perform additional responsibilities as needed to support evolving business priorities. Requirements: Bachelor’s degree or an equivalent combination of education and relevant professional experience. Minimum of 2 years of experience in patient access, financial counseling, utilization management, or a related healthcare support function. Experience supporting patients in behavioral health or substance use disorder (SUD) settings is strongly preferred. Previous experience discussing insurance coverage, benefits, and financial responsibilities directly with patients is preferred. Familiarity with telehealth workflows and remote healthcare environments. Experience communicating with insurance payers and navigating commercial, Medicare, and Medicaid plans, particularly within behavioral health or SUD services. Experience using healthcare technology platforms such as EMRs, revenue cycle management systems, ticketing platforms, and Microsoft Office or Google Workspace tools. Strong analytical skills with the ability to interpret data, identify trends, and support operational decisions. Excellent communication skills with the ability to interact professionally, clearly, and with cultural sensitivity. Highly organized, adaptable, and capable of managing multiple priorities in a fast-paced environment. Comfortable working independently, exercising sound judgment, and handling sensitive information with professionalism and discretion. Quick learner who can understand new insurance plans, payer processes, and internal systems efficiently. Reliable internet and phone access required for remote work, including minimum connection standards of 40 Mbps download and 10 Mbps upload with a strong Wi-Fi signal. Ability to meet required pre-employment conditions, which may include background checks, fingerprinting, health screenings, or drug testing depending on applicable regulations. Benefits: Competitive hourly compensation ranging from $19.05 to $25.16 per hour. Opportunity to work in a purpose-driven healthcare environment focused on improving access to care. Remote work flexibility with the ability to support members from a virtual setting. Exposure to healthcare operations, insurance processes, and innovative approaches to improving patient financial experiences. Collaborative workplace culture focused on teamwork, continuous improvement, and meaningful impact. Opportunities to develop expertise in eligibility, benefits coordination, and healthcare financial operations.
• How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best! Why Apply Through Jobgether? Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time. #LI-CL1
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