Quality Control Reviewer I

Employment Type: Full time, Permanent, Non-Exempt
Workplace Arrangement: Hybrid
Fund: 1199SEIU National Benefit Fund

Responsibilities

• Analyze Coordination of Benefits (COB) information received from members and other insurance companies to establish primary and secondary eligibility for spouse and dependents
• Communicate via telephone with members, insurance carriers, and other professionals regarding COB inquiries
• Respond to inquiries regarding COB from departments within the Fund (i.e., Provider Relations, Member Services)
• Prepare and mail letters to members and/or employers regarding the Coordination of Benefits
• Conduct investigation, when necessary, in determining COB eligibility
• Update COB patient maintenance screens and other applicable screens in the enrollment processing system Vitech (V3) for the National Benefit Fund, Greater and New York Benefit Fund
• Prepare weekly and monthly production reports via Microsoft Excel
• Perform additional duties and projects as assigned by management

Qualifications

• High School Diploma or GED required; some College or Degree preferred
• Minimum two (2) years relevant clerical experience in a general office environment required; high volume telephone customer service experience preferred
• Basic skill level in Microsoft Excel and Word preferred
• Knowledge of all Funds (NBF, GNY, GNJ) eligibility criteria
• Knowledge of eligibility systems and COB guidelines
• Excellent oral and written communication skills; ability to speak in a clear and concise manner
• Excellent customer service skills and ability to maintain a pleasant attitude; provide professional and courteous service to members
• Ability to prioritize work with tight schedules and target dates
• Problem solver with ability to work independently and as a team player
• Available to work overtime including Saturdays preferred
• Must meet performance standards including attendance and punctuality