Responsibilities

·Greet and assist members and advocates at service center; review and validate member demographics against database to measure system accuracy.

·Maintain HIPAA compliance while communicating with members and advocates in person or by telephone regarding all 1199SEIU benefits and programs (include but not limited to Eligibility, member enrollment, Retiree Health benefits and Pension).

·Resolve member issues related to pension, claims, benefits and payments, answer questions regarding policies, active & retiree programs and services.

·Review and verify submitted Pension applications and forms ensure all required documentation is provided and complete; copy submitted documents and forward to appropriate area via scanning to DMS or fax.

·Explain application process and assist members with enrollment for the 1199SEIU Medicare Advantage Plan or Medicare Part D; verify member’s primary care physician participation with 1199SEIU benefit plans.

·Schedule interviews with prospective pensioners; update members with status of pension applications.

·Assist Retirees with Request for Information forms (SSA forms).

·Verify, establish and re-establish benefits for members and eligible dependents enrolled in all Funds using various systems (V3, QNXT, CVS, etc.), receive Premium Payments for applicable Funds (GNY, HHA, etc.), receive COBRA payments and provide invoices for COBRA inquiries.

·Provide secondary level resolutions to escalated client concerns and where appropriate engage other departments (i.e. Eligibility, Medical Claims and Pension) to resolve member inquiries.

·Take the lead in assisting window and/or telephone representatives with difficult and complex issues that require proven business techniques and professional judgment that support effective results and positive outcomes.

·Identification and development of training opportunities that support streamlining of operational processes and support departmental trainings and/or side-by-side mentoring of staff. Work closely with team members to advise them on policies and best practices for supporting a “customer first” agenda.

·Perform additional duties and projects as assigned by management.

Qualifications

·High School Diploma or GED required, some College or Degree preferred.

·Minimum five (5) years’ experience as a Telephone Representative and/or Member Service Representative in a customer service environment or health plan or benefits environment required.

·Comprehensive knowledge of 1199SEIU Benefit and Pension Fund eligibility guidelines, benefit entitlements, and plan rules for multiple Funds (1199SEIU National Benefit Fund, 1199SEIU Greater New York and New Jersey, 1199SEIU Home Care Fund and LPN) are required.

·Knowledge of pension operations and systems (eligibility, disability, medical, pension, etc.) required.

·Knowledge of all types of extended coverage (i.e. Disability Benefits, Family Medical Leave Act (FMLA) and Worker’s Compensation).

·Knowledge of call tracking systems, eligibility systems and all web-based applications (i.e. Vitech, Iris, iObserver and QNXT); basic knowledge of Microsoft Outlook, Excel and Word preferred.

·Excellent communications skills – oral, written and listening; excellent interpersonal skills including courtesy, tact and discretion. A positive “can-do” attitude. Ability to use positive language.

·Demonstrated ability to meet quality and productivity standards.

·Demonstrated real-time problem- solving capabilities with the ability to pivot based on business and customer needs.

·Ability to maintain a professional manner; ability to maintain a pleasant attitude to ensure excellent service to members and advocates.

·Able to work well under pressure, multi-task, establish priorities, meet deadlines, and follow through on assignments.

·Hours of operation are from 8:00 am - 6:00 pm; shifts are subject to change and/or availability.

·Must meet performance standards including attendance and punctuality.