Quality Control Reviewer I

1199-Seiu; New York (NY); On-site; USD 42,000 - 56,000; Full time

Job summary

1199-SEIU in New York seeks a COB Coordinator to analyze Coordination of Benefits data and determine primary and secondary eligibility for spouses and dependents. You will communicate with members, insurers, and professionals by phone regarding COB inquiries and prepare related correspondence.

The role requires 2+ years of clerical experience in a busy office, with strong Excel/Word skills and knowledge of funds eligibility criteria. Overtime may be required.

Qualifications

• High school diploma or GED required; some college or degree preferred.
• Minimum two years clerical experience in a general office environment; high-volume telephone customer service preferred.
• Knowledge of eligibility criteria across Funds (NBF, GNY, GNJ).
• Excellent oral and written communication; courteous, professional service.

Responsibilities

• Analyze COB information to establish primary/secondary eligibility for spouse and dependents.
• Communicate via telephone with members, carriers, and professionals regarding COB inquiries.
• Respond to COB inquiries from Fund departments (Provider Relations, Member Services).
• Prepare and mail COB letters to members or employers.
• Investigate COB eligibility when necessary.
• Update COB data in enrollment system Vitech (V3) for National Benefit Fund and related funds.
• Prepare weekly and monthly production reports via Microsoft Excel.
• Perform additional duties and projects as assigned by management.

Education

High School Diploma or GED

Some college or degree preferred

Tools

Microsoft Excel

Microsoft Word

Job description

Responsibilities

• Analyze Coordination of Benefits (COB) information received from members and other insurance companies to establish primary and secondary eligibility for spouse and dependents
• Communicate via telephone with members, insurance carriers, and other professionals regarding COB inquires
• Respond to inquiries regarding COB from departments within the Fund (i.e. Provider Relations, Member Services)
• Prepare and mail letters to members and/or employers regarding the Coordination of Benefits
• Conduct investigation, when necessary, in determining (COB) eligibility
• Update COB patient maintenance screens and other applicable screens in the enrollment processing system Vitech (V3) for the National Benefit Fund, Greater and New York Benefit Fund
• Prepare weekly and monthly production reports via Microsoft Excel
• 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 relevant clerical experience in a general office environment required; high volume telephone customer service experience preferred
• Basic skill level in Microsoft Excel andWord preferred
• Knowledge of all Funds (NBF, GNY, GNJ) eligibility criteria
• Knowledge of eligibility systems and COB guidelines
• Excellent oral and written communication skills; ability to speak in a clear and concise manner
• Excellent customer service skills and ability to maintain a pleasant attitude; provide professional and courteous service to members
• Ability to prioritize work with tight schedules and target dates
• Problem solver with ability to work independently and as a team player
• Available to work overtime including Saturdays preferred
• Must meet performance standards including attendance and punctuality