Team Lead, Coordination of Benefits (COB) - Jefferson Health Plan

Job Details

The Coordination of Benefits (COB) Team Lead is responsible for overseeing day-to-day COB and Third-Party Liability operations, including work inventory management, staff performance, quality oversight, and coordination with internal and external partners. This role provides leadership and subject matter expertise to ensure accurate determination of benefit primacy, timely resolution of COB activity, and appropriate claim rework or recovery actions. The Team Lead plays a critical role in scaling internal COB operations, improving efficiency, and reducing reliance on external vendors.

Job Description

• Leads and oversees a team of COB Analysts, providing daily direction, coaching, and performance oversight. Manages COB inventory prioritization, balancing value, risk, timeliness, and regulatory requirements to ensure optimal use of internal and external resources.
• Serves as a subject matter expert on Coordination of Benefits, including application of CMS Medicare Secondary Payer (MSP) rules and NAIC commercial COB guidelines.
• Reviews complex or escalated COB cases, providing guidance on coverage determinations, primacy decisions, and downstream claim impacts. Provides oversight of external TPL vendors, including monitoring performance, validating outputs, resolving issues, and ensuring alignment with internal COB policies and workflows.
• Oversees quality review of COB work to ensure accuracy, consistency, and compliance with regulatory and internal standards. Develops, maintains, and analyzes COB operational reports to deliver data-driven insights on productivity, inventory aging, quality, and financial impact. Identifies and implements process improvements informed by reporting trends to improve efficiency, reduce rework, and enhance COB outcomes.

Required Education and Experience:

• High School Diploma/GED with relevant experience.
• 5 years of experience in healthcare insurance operations, including hands-on experience with Coordination of Benefits (COB) and/or Third-Party Liability (TPL), with demonstrated application of CMS Medicare Secondary Payer (MSP) rules and NAIC commercial COB guidelines.
• 2 years of experience in a lead, supervisory, or team oversight role, including responsibility for inventory prioritization, quality review, staff performance, and coordination with internal stakeholders or external vendors.
• Advanced knowledge of Coordination of Benefits and Third-Party Liability operations, including application of CMS Medicare Secondary Payer (MSP) rules and NAIC commercial COB guidelines to support accurate benefit primacy determinations.
• Strong leadership and operational management skills, with demonstrated ability to prioritize inventory, oversee vendor performance, manage team outcomes, and drive accountability in a production environment.
• Ability to analyze operational and financial data to generate actionable insights, inform decision-making, identify trends, and implement process improvements.

Preferred Qualifications

• Bachelor’s Degree in Healthcare Administration, Business, Finance, or a related field.
• Experience working with SQL-based relational databases or querying tools to support reporting, data analysis, or operational insights preferred.

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Health Partners Plans, Inc.

Primary Location Address

901 Market Street, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research.