Unlocking the value of employment verification in coordination of benefits

Accurate coordination of benefits (COB) is essential for payers seeking to optimize payment integrity and member satisfaction. One of the most impactful, yet often underutilized, strategies for achieving this is employment verification (EV). By ensuring that a member’s working status is consistently up to date—throughout the entire year—plans can identify overpayments, improve compliance, and create an experience for all stakeholders that minimizes friction. Here are three best practices to consider.

Internal education and communication

The foundation of any successful employment verification process lies in securing buy-in and alignment from internal teams. Account executives and other internal stakeholders are the “gatekeepers” to employer groups, and their understanding of EV’s role in COB is critical.

By investing in robust education and communication, health plans ensure that everyone is on board with the value of accurate employment data collection and its direct impact on COB savings. 

Cotiviti’s methodical approach includes comprehensive training, transparent outreach timelines, and resources designed to address common questions about employer engagement and its impact to members.

When internal teams are well-prepared, outreach efforts become more coordinated and effective. This alignment also helps prevent fragmented communications and confusion, setting the stage for strong, consistent relationships with employer groups. Cotiviti’s representatives work closely with client stakeholders to design processes that are both effective and minimally disruptive, further solidifying internal support.

Tailored employer group outreach

A one-size-fits-all approach rarely succeeds when engaging employer groups. The ideal strategy emphasizes authenticity and transparency, ensuring employers understand the purpose and value of employment verification. By providing written communications, such as sample questionnaires and FAQs, and offering virtual Q&A sessions, plans can reduce friction and encourage employer participation.

Plans must also adapt to the unique administrative calendars and needs of each employer group.

A customer-first philosophy means outreach is carefully timed and requests are limited to the minimum necessary data, minimizing disruption for employer contacts and their employees. This consultative approach not only ensures access to needed information but also fosters positive, collaborative relationships that reduce the risk of claim denials caused by outdated or incomplete data.

Structured data gathering and dissemination

Accurate, up-to-date data is the lifeblood of an effective COB program. Cotiviti begins with analytical member selection, targeting high-suspect members based on claim history and demographic data to maximize the ROI of each outreach. Data is gathered through documented, trackable processes—often starting with tailored outreach to employer groups by email or phone—to ensure completeness and compliance. Once collected, findings are systematically shared with internal partners, demonstrating the tangible value employment verification brings to the program. 

The results speak for themselves: Cotiviti clients that have enabled employment verification have achieved:

*Across all COB clients with EV compared to those without EV.
**Across a subset of five clients ranging from large national to regional Blue Plans.

Here’s a practical example of effective EV in action: Suppose a member has Medicare Part A on basis of disability, effective January 1, 2026. Per the eligibility system, the member is enrolled in an active group with >100 employees. Research reveals the member has a claims history indicating they are not actively working. Cotiviti then performs outreach to the employer and determines the member has been on disability leave since January 1, 2025. Per MSP Chapter 2, Section 10.5A, the member does not have current employment status as of July 1, 2025. Therefore, Medicare is primary as of January 1, 2026. The plan therefore recovers the paid claims from Medicare, creating no friction with the member or providers.