COB Specialist, Payment Integrity

Location: Fully remote, open only to candidates residing in Atlanta, Chicago, Dallas, Louisville, Minneapolis, Philadelphia, or Salt Lake City, United States. Future work models may include hybrid presence at the associated hub office.

Salary: $64,832–$85,092 per year, plus annual performance bonuses.

Company

hirify.global is a health insurance company built around a full-stack technology platform and a focus on member service.

What you will do

• Investigate and verify proper payment of Oscar medical and pharmacy claims, including confirming whether dual coverage exists.
• Serve as a subject matter expert on Coordination of Benefits reimbursement policies and respond to related inquiries and disputes.
• Create new COB workflows, improve existing processes, and drive COB audits.
• Analyze claims data and partner submissions to identify payment issues, root causes, and opportunities for COB solutions.
• Translate research findings into business requirements and collaborate with internal and external partners to prioritize and deliver improvements.
• Support escalated issues through research, root-cause analysis, training, and clear stakeholder communication.

Requirements

• Bachelor’s degree or 4+ years of equivalent experience.
• 4+ years of experience in payment integrity, ideally in Coordination of Benefits.
• Experience with COB reimbursement methodologies, provider contract concepts, and claims processing and resolution practices.
• 2+ years of experience deriving business insights from datasets and solving problems.
• 1+ year of experience improving business workflows and processes.
• 1+ year of experience collaborating with internal or external stakeholders.

Nice to have

• 2+ years of experience working with large datasets using Excel or a database language, preferably SQL.
• Experience with pharmacy Coordination of Benefits.
• Experience in a professional healthcare claims organization.
• Knowledge management, training, or operational content development experience.

Culture & Benefits

• Full-time employment with medical, dental, and vision benefits.
• Unlimited vacation program, 11 paid holidays, paid sick time, paid parental leave, and paid wellness time.
• 401(k) plan participation, life and disability insurance, and wellness reimbursements.
• Equal opportunity environment focused on belonging, authenticity, and collaboration.