Diane M Combs
Macomb,MI
Summary
Detail-oriented Coordination of Benefits (COB) Analyst with over 30 years of experience in the healthcare industry. Proficient in analyzing insurance claims and identifying coordination of benefits opportunities. Employ knowledge of Federal and State COB laws, including National Association of Insurance Commissioners (NAIC) and Employee Retirement Income Security Act (ERISA) to drive accuracy in claims processing when other insurance coverage is present.
Overview
23
23
years of professional experience
Work History
Coordination of Benefits (COB) Analyst
Health Alliance Plan (HAP)
Troy , MI
2001.06 - Current
- Performed end to end coordination of benefits activities from verification of other insurance to claims processing.
- Processed subrogation claims related to auto, accident, and workman’s compensation.
- Analyze claims to identify coordination of benefits opportunities, ensure correct payment determinations and minimize potential overpayments.
- Adjudicated claims, including crossover claims, from other insurance carriers.
- Collaborate with internal teams, insurance carriers, and third-party administrators resolve coordination of benefits issues and discrepancies.
- Maintained knowledge base of Federal and State COB laws, including NAIC and ERISA.
- Ensure compliance with regulatory guidelines and company policies and maintain accurate records of all processes.
- Participate in regular meetings with leadership to assess and address issues and identify and implement improvements.
- Assist in training new staff.
Education
High School Diploma -
L’Anse Creuse North High School
Skills
- Coordination of benefits analysis
- Insurance claims processing
- Healthcare regulations and compliance
- Proficiency in healthcare software and databases
- Data analysis and reporting
- Problem-solving and critical thinking
- Attention to detail and accuracy
- Communication and interpersonal skills
- Team collaboration
- MS Office (Word, Excel, PowerPoint) and enrollment/claims management software
Training
Effective Writing and Grammar
Coordination of Benefits
Medical Terminology
References
Available upon request
Timeline
Coordination of Benefits (COB) Analyst
Health Alliance Plan (HAP)
2001.06 - Current
High School Diploma -
L’Anse Creuse North High School
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