COB Retraction Coordinator

Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We're constantly reimagining what's possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.

At Machinify, we're constantly reimagining what's possible in our industry, creating disruptively simple, powerfully clear ways to maximize our clients' financial outcomes today and drive down healthcare costs tomorrow. As part of the COB team, you will provide critical support to the Medical Claims Overpayment Identification Program while also assisting with coordination of benefits (COB) functions and healthcare claims workflows. This role ensures accurate claims research, documentation, communication, and resolution across all retraction clients and provider partners.

What you'll do

• Track and manage weekly Excel reports received through a secure reporting portal, including response files and detailed status updates for members and claims.
• Maintain accurate and organized supporting documentation for all investigations.
• Prepare and compile supporting documentation for fee invoices.
• Review potential claim overpayments and ensure identified overpayments are processed accurately and within required timeframes, consistent with industry standards for overpayment recovery roles.
• Generate overpayment recovery communications as needed and clearly document reasons for retractions, reflecting best practices in claims recovery operations.
• Respond to provider inquiries regarding claim status, overpayment determinations, or refunds via phone or written communication.
• Gather and maintain COB data, including researching payer status, determining insurance coverage, and updating records to ensure accurate claims processing.
• Verify patient eligibility, coverage details, and benefit sequencing to ensure correct primary/secondary payer alignment.
• Investigate and resolve discrepancies related to COB information or claim denials.
• Collaborate with internal teams to address configuration issues, eligibility discrepancies, and other factors impacting coordination of benefits.
• Maintain uptodate knowledge of insurance policies, Medicare/Medicaid rules, and COB regulations.
• Assist in researching provider questions, appeals, and documentation requests.
• Communicate directly with clients to address questions, ensure alignment, and deliver program updates.
• Distribute daily workloads to Retraction Processors to support timely claim resolution.
• Prepare and maintain internal reports supporting operational oversight and performance tracking.

What experience you bring (Role Requirements)

• Medical claims processing or claims review experience, including familiarity with claim codes, benefit coordination, and insurance plan structures.
• Strong attention to detail and accuracy.
• Ability to work with minimal supervision.
• Proficiency in Microsoft Excel and Word.
• Ability to research and interpret benefits, eligibility rules, and payer guidelines aligning with modern COB and claims coordinator expectations.
• 2-4 years of experience in claims processing, customer service, claims coordination, reimbursement, payment integrity, or related healthcare roles; or an equivalent combination of education and experience.
• Experience in claims overpayment, appeals processing, or COB preferred.

What Success Looks Like...

After 3 months

• You will have a strong understanding of the role.
• You begin building relationships and collaborating with peers.
• You develop effective time and priorities management.
• You receive initial feedback about your performance and are using it to improve.
• You've gained confidence in your abilities and are starting to feel more comfortable in your role.

After 1 year

• You have mastered the tasks and responsibilities of the position, executing them with confidence and efficiency.
• You have established a strong network of internal relationships and are recognized as a key collaborator.
• You've been entrusted with greater responsibility indicating the company's confidence in your abilities.
• You see opportunities for career progression and personal development.

Pay range: $55,000 - $60,000. This is an exempt position. Compensation will be determined based on several factors including, but not limited to, skill set, years of experience, and the employee's geographic location.

What's in it for you

• PTO, Paid Holidays, and Volunteer Days
• Eligibility for health, vision and dental coverage, 401(k) plan participation with company match, and flexible spending accounts
• Tuition Reimbursement
• Eligibility for company-paid benefits including life insurance, short-term disability, and parental leave.
• Remote and hybrid work options

What values we'll share with you

• Ask why
• Think big
• Be humble
• Optimize for customer impact
• Deliver results