TBC Corporation

Compensation

Full Description

Lyric is an AI-first, platform-based healthcare technology company, committed to simplifying the business of care by preventing inaccurate payments and reducing overall waste in the healthcare ecosystem, enabling more efficient use of resources to reduce the cost of care for payers, providers, and patients. Lyric, formerly ClaimsXten, is a market leader with 35 years of pre-pay editing expertise, dedicated teams, and top technology. Lyric is proud to be recognized as 2025 Best in KLAS for Pre-Payment Accuracy and Integrity and is HI-TRUST and SOC2 certified, and a recipient of the 2025 CandE Award for Candidate Experience. Interested in shaping the future of healthcare with AI? Explore opportunities at lyric.ai/careers and drive innovation with #YouToThePowerOfAI. Applicants must already be legally authorized to work in the U.S. Visa sponsorship/sponsorship assumption and other immigration support are not available for this position. The Sr. Payment Integrity Specialist (COB) serves as a subject matter expert within the Coordination of Benefits (COB) program, leading moderate-to-complex investigations to validate other insurance coverage, resolve conflicting eligibility information, and establish the correct order of liability (primary vs. secondary payer) to prevent and recover improper claim payments. This role performs hands-on casework in a high-volume environment including outreach, documentation, and system updates, while applying advanced analytical skills to interpret claims and eligibility data, identify trends and false positives, and drive process and reporting improvements that improve accuracy and outcomes for the COB program. ESSENTIAL JOB RESPONSIBILITIES & KEY PERFORMANCE OUTCOMES Investigation and verification Review, prioritize, and independently work assigned COB leads (automated and manual), including moderate-to-complex and high-dollar cases, to determine verification steps and next actions. Investigate and validate coverage details (payer, plan type, subscriber relationship, policy indicators, effective/termination dates) using internal systems, payer portals, EOBs/claim responses, and other approved data sources. Apply COB rules and guidelines, including CMS and NAIC guidance as applicable, to determine the correct order of liability and document the rationale for the primacy determination. Reconcile discrepancies across sources (eligibility feeds, member/group data, claim history, and third-party responses) and drive cases to a clear, audit-ready determination; escalate edge cases per policy. Outreach, documentation, and system updates Contact insurance carriers, employers, clearinghouses, providers, and other third parties as needed to confirm or clarify coverage information and obtain supporting evidence. Create clear, detailed, and accurate case notes that capture verification steps, evidence, and outcomes in internal tools to support audits and downstream recovery/reprocessing. Update eligibility/COB records and coordination rules based on verified information and confirm updates are applied correctly to reduce downstream adjudication errors and abrasion. Prepare and evaluate documentation needed for inquiries, client/provider disputes, and appeals related to determinations, as assigned. Quality, SME support, and operational ownership Perform quality checks on your work and as assigned, peer outputs prior to submission/export to ensure accuracy, completeness, and compliance with internal standards and regulatory expectations. Serve as a COB SME: provide knowledge share, mentoring, and coaching to Specialists; support new hire onboarding and training as needed. Support inventory management by helping to isolate and distribute work and by proactively flagging capacity, risk, and prioritization needs to leadership. Meet or exceed established productivity, turnaround time, and quality/audit standards while managing a high-volume case queue with a high degree of autonomy. Process improvement and analytical contribution Identify and solve problems by surfacing errors and overpayments, documenting root causes, and recommending corrective actions that reduce rework and improve yields. Track outcomes and error categories, identify drivers of recurring issues and false positives, and recommend opportunities to streamline research, improve data quality, and enhance logic. Use advanced Excel and other tools to support ad hoc analysis (e.g., trend review, inventory quality checks, and performance insights); develop simple trackers or reporting views to support operational decisions. Demonstrate strong understanding of query and filter construction (and/or similar investigative tooling) to identify opportunities; partner with stakeholders to test and implement workflow or tool enhancements and measure impact. REQUIRED QUALIFICATIONS Minimum of eight (8) years of related healthcare experience (e.g., COB/TPL, eligibility, claims operations, billing, recovery, or payment integrity). Minimum of eight (8) years of experience performing COB investigations and/or payment integrity casework, including independent ownership of moderate-to-complex inventories. Advanced proficiency with Excel and comfort working with large data sets and multiple systems/portals; ability to produce clear summaries and operational insights. Working knowledge of coordination of benefits rules, primary/secondary payer logic, coverage hierarchy, and order-of-liability concepts; understanding of CMS and NAIC guidance as applicable. Demonstrated ability to analyze and reconcile information across multiple sources (eligibility feeds, member/group data, claim history, payer portals, EOBs/claim responses). Ability to work within established productivity and quality metrics while prioritizing workload with minimal supervision. Strong problem-solving skills with the ability to resolve conflicting or incomplete information and escalate appropriately. Ability to maintain confidentiality and comply with HIPAA and data security standards. PREFERRED QUALIFICATIONS Bachelors degree in business or healthcare/related field Experience performing quality review/quality control and providing feedback or coaching to improve team outcomes. Demonstrated process improvement experience (e.g., SOP development, workflow redesign, training updates) with measurable impact on accuracy, turnaround time, or false positives. Familiarity with eligibility data workflows, payer portals, and third-party data sources used in COB validation. Working knowledge of claim adjudication workflows and payment rules. Experience building queries/filters or using reporting tools to identify opportunities; basic SQL or query-tool proficiency is a plus. Experience in high-volume, SLA-driven operations teams; comfort operating in a metric-driven environment. Creative thinker with an entrepreneurial spirit ***The US base salary range for this full-time position is: $85,018.00 - $127,526.00 The specific salary offered to a candidate may be influenced by a variety of factors including but not limited to the candidate’s relevant experience, education, and work location. Please note that the compensation details listed in US role postings reflect the base salary only, and does not reflect the value of the total rewards compensation. *** Lyric is an Equal Opportunity Employer that strives to create an inclusive environment, empower employees and embrace collaborative success. Our ambition is to be an AI-first platform sitting at the intersection of healthcare and fintech, providing simplified consumer and patient solutions to plans and providers in the wake of value-based care while continuously identifying the unmet needs of customers