Responsibilities
Maintain HIPAA compliance while communicating with 1199SEIU members and advocates via telephone or written correspondence regarding benefit eligibility, claim submissions and plans, programs and services
Distinguish the benefit plans per Fund; identify their appropriate enrollment and eligibility rules and required documentation
Verify, establish and re-establish member eligibility for new or existing members, spouses and dependents using the eligibility and enrollment systems (Syntonics, QNXT, V3, and Member Portal)
Request required proof of wages or hours worked as necessary; forward documentation to the Eligibility Department to update member eligibility records
Research status of hospital and medical claim payments and benefit checks
Verify coordination of benefits with other carriers and agencies
Create call tracking records (QNXT) to assign and distribute inquiries to the appropriate departmental folders for resolution (i.e. claims, checks, Explanation of Benefits, enrollment and eligibility issues)
Compose and mail printed materials at member's request; provide list of participating providers, Primary Care Physician's (PCPs) and Member Choice Networks
Alert members of new plan changes, plan improvements, or special event dates and locations
Respond to outbound inquiries which includes voicemails and emails
Access web-based applications relevant to member inquiries (iObserver, Medco, IRIS)
Print verification letters for Members; Print EOBs after January 1, 2008
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 high volume customer service experience in a call center environment; or two (2) years health claims processing experience required
Keyboarding skills required (minimum 5,000 KPH and 80% accurate rate)
Knowledge of health claims processing systems (QNXT, Syntonics, V3) and Fund eligibility requirements preferred (1199SEIU National Benefit Fund, Greater New York Fund, Greater New Jersey Fund, Home Care Fund, Home Health Aide Fund)
Excellent written and verbal communication skills with great interpersonal skills
Able to initiate correspondence and maintain a pleasant attitude to ensure excellent service to members and providers
Ability to work well under pressure due to the high volume and urgent nature of calls
Call Center hours of operation are from 8:00 am until 6:00 pm; shifts are subject to change and/or availability
Telephone Representative II • New York, NY, US
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