About Fallon Health:
Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit www.fallonhealth.org
Brief Summary of Position:
Process secondary COB claims utilizing other insurance company explanation of benefits (EOB). Process Motor Vehicle Accidents (MVA) and Workers Compensation (WC) claims utilizing letter received from other insurance company. Work with members, other insurance companies, employer groups and providers to determine primacy, following NAIC guidelines. Adhere to department goals for timeliness and accuracy.
COB and Subrogation experience with both Commercial and Regulatory products and the associated regulations preferred.
Specific competencies essential to this position:
High School Diploma, college degree preferred