1199SEIU Funds
divh2Job Title/h2pstrongResponsibilities/strong/pulliMaintain HIPAA compliance while communicating with 1199SEIU members and advocates via telephone or written correspondence regarding benefit eligibility, claim submissions and plans, programs and services./liliDistinguish the benefit plans per Fund; identify their appropriate enrollment and eligibility rules and required documentation./liliVerify, 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)./liliRequest required proof of wages or hours worked as necessary; forward documentation to the Eligibility Department to update member eligibility records./liliResearch status of hospital and medical claim payments and benefit checks./liliVerify coordination of benefits with other carriers and agencies./liliCreate 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)./liliCompose and mail printed materials at members request; provide list of participating providers, Primary Care Physicians (PCPs) and Member Choice Networks./liliAlert members of new plan changes, plan improvements, or special event dates and locations./liliRespond to outbound inquiries which includes voicemails and emails./liliAccess web-based applications relevant to member inquiries (iObserver, Medco, IRIS)./liliPrint verification letters for Members; Print EOBs after January 1, 2008./liliPerform additional duties and projects as assigned by management./li/ulpstrongQualifications/strong/pulliHigh School Diploma or GED required; some College or Degree preferred./liliMinimum two (2) years high volume customer service experience in a call center environment; or two (2) years health claims processing experience required./liliKeyboarding skills required (minimum 5,000 KPH and 80% accurate rate)./liliKnowledge 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)./liliExcellent written and verbal communication skills with great interpersonal skills./liliAble to initiate correspondence and maintain a pleasant attitude to ensure excellent service to members and providers./liliAbility to work well under pressure due to the high volume and urgent nature of calls./liliCall Center hours of operation are from 8:00 am until 6:00 pm; shifts are subject to change and/or availability./li/ul/div