What are the responsibilities and job description for the Quality Control Reviewer III position at 1199SEIU Family of Funds?
Requisition #:
7118
# of openings:
1
Employment Type:
Full time
Position Status:
Permanent
Category:
Bargaining
Workplace Arrangement:
Hybrid
Fund:
1199SEIU National Benefit Fund
Job Classification:
Non-Exempt
Responsibilities:
- 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
