Responsibilities. Review and authorize pension benefits for retired 1199SEIU members, surviving spouses, beneficiaries and their estates. ensure benefits are processed in compliance with Federal and Plan regulations. Verify pension calculations and medical benefit entitlements for members who receive counseling. ensure members are informed of accurate pension and medical benefits due to them upon retirement. Maintain counts of daily production in...
R. es. p. on. s. i. b. ili. t. i. es. Optimize work processes to independently conduct comprehensive research to gather information regarding member appeals and provider inquiries by analyzing, evaluating and investigating all issues involved, then collaborating with applicable departments to ensure timely handling of appeals in accordance with the current Fund’s policies, guidelines, and regulatory requirements. Provide written acknowledgments t...
Responsibilities. Evaluate and make appropriate determinations of disability claims in accordance with applicable state laws (NY and NJ) and Fund procedures. Request required disability claim information from 1199SEIU members, physicians and employers to process new and ongoing disability claims. Analyze and evaluate medical and vocational information to determine a member’s inability to work and to assist in return-to-work efforts while member i...
Responsibilities. Provide comprehensive telephonic case management to targeted population who are identified with chronic diseases, as well as medically complex members referred for outreach. Develop a tailored plan of care that supports the needs of the members, influences adherence to treatment, assist with discharge planning as needed and care coordination to ensure optimal outcomes. Apply nationally recognized clinical evidence-based guidelin...
Responsibilities. Designs, develops, organizes, prepares and conducts training courses and coaching initiatives for Fund employees. Ensures programs are consistent with the Fund mission, the Collective Bargaining Agreement (CBA), comply with legal requirements, and promote positive employee relations. Assists in the preparation and set up of training courses, skill development sessions and materials and/or the procurement of outside training sour...
Responsibilities. Manage the activities of physician contracting which include preparing and maintaining contracts and complex contracting and negotiations for fee for service, and value-based reimbursements with providers (e.g., large physician groups). Draft single case Letter of Agreements and Long-term Letter of Agreements with providers and physician groups. Develop reimbursement models and negotiate renewal agreements with large physician g...
Responsibilities. Research and write communications pieces, including letters, postcards, flyers, brochures, podcast content, eBlasts to providers and employers, phone scripts, voiceblasts, surveys, presentations, and copy for Intranet and external Funds’ website. Review communications from all Funds’ departments and outside vendors that are sent to members, employers and providers to ensure they are accurate, easily understood and audience-appro...
The Retired Members Division is in need of a Knitting & Crochet Instructor to work with retired members at our 498 7th Avenue Location. Date & Time to be determined. Average length of class is two (2) hours, one day per week and 4 classes per month. Payment - stipend of $180 per month. Requirements. Minimum five (5) or more years of Knitting and Crocheting teaching experience is required. (needlecrafts teacher). Ability to follow Knitting and Cro...
Responsibilities. Collaborate with the Assistant Director, Model Office Team, and IT Applications Development Team to support key Eligibility Department initiatives from an analysis and testing perspective. Develop business test cases to test system logic changes and program modifications to ensure logic is operating according to business guidelines and design specifications. Conduct User Acceptance Testing (UAT) for various Eligibility projects ...
Responsibilities. Provide professional and administrative support to the Director and the Assistant Directors of Provider Relations. Manage calendars. Coordinate with multiple internal departments and external personnels to secure in person and virtual meetings and conferences, as directed. Prepare meeting agendas and compile documents in advance. Vet and address calls, resolve complaints and respond to inquiries on the telephone, in person, and ...
