Quality Control Reviewer III

Responsibilities:

• Greet and assist retirees over the phone and via email; review and validate member demographics against database to measure system accuracy.
• Assist 1199SEIU retired members with inquiries regarding Retiree Health and Pension Benefit eligibility and payment status.
• Review and verify submitted Pension applications and forms ensuring all required documentation is provided and complete
• Explain application process and assist members with enrollment for the 1199SEIU Medicare Advantage Plan or Medicare Part D; assist members with Aetna MAPD enrollment
• Schedule interviews with prospective pensioners; update members with status of pension applications
• Communicate with members, via telephone and/or email regarding claims and other benefit related inquiries; provide support to Telephone Representatives as needed.
• Troubleshoot problems, assist members/retirees in resolving difficult and complex issues related to pension, claims, retiree benefits and payments, answer questions regarding policies, retiree programs and service.
• Partner with various departments (i.e.: Eligibility, Medical Claims and Pension) to resolve member inquiries.
• Compose verification letters, generate duplicate 1099R tax forms, explanation of benefits and health identification cards at members’ request; request letters of Creditable Coverage as needed.
• Access web-based applications relevant to inquiries (i.e.: V3, QNXT, Superscreen, BeneFaqs, Medco, iObserver, DocFind, etc.)
• 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’ experience in a high-volume call center as a Telephone Representative in a health insurance or benefits environment required.
• Knowledge of 1199SEIU Benefit and Pension Fund eligibility guidelines, benefit entitlements, and plan rules for multiple Funds (Greater NY Benefit Fund, Home Care Employees Pension Fund and National Benefit Fund).
• Knowledge of pension operations and systems (Eligibility, Disability, Medical, Pension, etc.) required.
• Knowledge of call tracking systems, eligibility systems and all web-based applications (i.e: V3, Iris, iObserver and QNXT); basic knowledge of Microsoft Outlook, Excel and Word preferred.
• Excellent communication skills – oral, written and listening; excellent interpersonal skills including courtesy, tact and discretion.
• Ability to maintain a professional manner; ability to maintain a pleasant attitude to ensure excellent service to
• Able to work well under pressure, multi-task, establish priorities, meet deadlines and follow through on assignments.
• Able to provide coverage at front windows and/or satellite offices due to operational needs.
• Call Center hours of operation are from 8:00am – 6:00pm; shifts are subject to change and/or availability.