Requisition #:

6877

# of openings:

1

Employment Type

Full time

Position Status

Permanent

Category

Bargaining

Workplace Arrangement

Hybrid

Fund

1199SEIU National Benefit Fund

Job Classification

Non-Exempt

Re Sponsibilities

Conduct audits of Provider Relations call center inquiries via various systems (i.e. Vitech, QNXT, and Call Tracking)
Communicate with providers, collection agencies, hospitals, doctors, dentists, lawyers, employers, and other professionals regarding health claims and other benefit inquiries; provide backup coverage to Telephone Representatives as needed
Assist Supervisor in reviewing work of call center staff and redistribute errors; provides departmental training and side-by-side mentoring of staff
Assist Telephone Representatives with difficult calls and resolve complex problems
Investigate issues, provider advances and assist providers with claim payments or adjustments
Work closely with various departments, insurance carriers and other agencies to resolve issues (i.e. Provider Relations, Claims, Finance, Eligibility and Coordination of Benefits)
Review eligibility and claims systems for errors and call track and/or escalate inquiries for corrections or adjustments
Review and monitor department call tracking folder, process call tracking inquiries, identify trends and troubleshoot problems
Access web-based or report applications relevant to provider inquiries (i.e. ABF, iObserver, intranet, on-demand reports, or external provider websites)
Review and search information using knowledge tool (i.e. BeneFAQs)
Must meet departmental performance standards
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 call center experience as a Telephone Representative in a health plan or benefits environment required
Comprehensive knowledge of eligibility, rules for extended or limited continuation of benefits (coordination of benefits, retiree extensions, enrollment)
Comprehensive knowledge of health benefits such as: hospital, surgical, x-ray, laboratory, major medical, etc.
Knowledge of 1199SEIU Fund benefits preferred (National Benefit Fund, Greater New York and Home Care Fund)
Experience navigating web based applications and Call Tracking Systems (Vitech, QNXT, iObserver and IRIS)
Excellent communication skills (written and verbal) and interpersonal skills; ability to maintain a pleasant attitude with providers to ensure customer satisfaction
Able to work well under pressure, multi-task, establish priorities, meet deadlines, and follow up
Strong ability to lead, mentor and motivate others, maintain professional manner and presentation
Good problem solver and excellent analytical skills
Call Center hours of operation are from 8:00 am until 6:00 pm; shifts are subject to change and/or availability
Must meet attendance and punctuality standards