Member Financial Specialist – Eligibility & COB

Overview

As a Member Financial Specialist – Eligibility & COB Focus, you will play a vital role in resolving Coordination of Benefits (COB) denials, addressing complex eligibility and coverage issues, and ensuring accurate and timely updates to member accounts. You will work closely with members and insurance carriers to resolve discrepancies, educate members about their benefits, and support initiatives that promote clean claims and reduce financial barriers to care.

The Member Financial Support function ensures that patients have a clear and consistent understanding of their financial responsibilities, supports accurate claims processing from the start of care, enforces transparent payment policies, and helps make care affordable and accessible to all.

You will also contribute to the organization’s mission and values by bringing a strong sense of purpose, empathy, and teamwork to every interaction and workflow.

Responsibilities

Essential Functions:

• Investigate and resolve COB denials by communicating directly with insurance carriers and membersConduct outreach to members to gather and update insurance details, verify coverage, and provide education on next steps
• Support special projects related to eligibility changes, contract updates, and coverage transitions
• Accurately update member accounts with verified insurance data, and notify members of any changes in benefits or financial responsibilities
• Perform routine and ad-hoc reporting to identify trends in COB denials, eligibility issues, and coverage discrepancies
• Run, interpret, and act on data reports to support operational improvements and targeted outreach
• Communicate professionally with members and insurance companies via phone, video, and written correspondence
• Review and process documents related to coverage updates, COB forms, and payer communications
• Maintain a strong understanding of insurance policies, benefits structures, and patient responsibility guidelines

Other Duties and Responsibilities:

• Perform other duties as assigned as the role and company evolve

Qualifications

Knowledge, Skills, and Abilities:

• Mission-driven: You are deeply invested in patient success and committed to advancing the organization’s mission
• Strong communicator and culture-bearer: You represent the organization’s values in every member interaction and communicate clearly, confidently, and with cultural sensitivity
• Adaptable in fast-paced environments: You thrive in dynamic settings and can respond quickly to member needs
• Collaborative: You excel at building strong relationships across teams and working toward shared goalsData-savvy: You enjoy using data to evaluate performance and inform decision-making
• Innovative thinker: You can challenge the status quo and propose creative, practical solutions
• Highly organized: You manage multiple priorities and moving pieces with precision and consistency
• Flexible and resourceful: You navigate ambiguity and rapid change with ease and professionalism
• Self-directed: You are comfortable working independently and exercising sound judgment
• Technologically proficient:
  • Comfortable operating an EMR, RCM and Microsoft Office/Google Products
  • Able to use video conferencing platforms and ticketing systems
  • Able to operate effectively in a remote environment
• Quick learner: Able to rapidly understand new insurance plans, payer processes, and internal tools
• Professional discretion: You handle sensitive information responsibly and ethically

Compliance: Understand and adhere to the organization’s Code of Conduct

Qualifications & Requirements:

• Bachelor’s degree or equivalent combination of education and experience required
• Minimum of 2 years of direct patient-facing experience in patient access, financial counseling, or utilization management; experience in SUD/Behavioral Health strongly preferred
• Experience with Apero is a plus
• Prior experience speaking with SUD/Behavioral Health patients about coverage, benefits, and patient responsibility
• Familiarity with working via telehealth
• Comfortable communicating directly with payers and navigating insurance organizations
• Strong working knowledge of commercial, Medicare, and Medicaid behavioral health/SUD plans
• Experience in a high-growth, dynamic environment is strongly preferred
• Access to reliable internet and phone services (minimum 40 Mbps download / 10 Mbps upload with strong Wi-Fi signal at remote location)
• Must meet all pre-employment requirements, which may include fingerprinting, drug testing, health screenings, and background checks based on state-specific guidelines