Quality Control Reviewer I

1199SEIU Benefit and Pension Funds; New York (NY); Hybrid; USD 55,000 - 65,000; Full time

Job summary

1199SEIU National Benefit Fund in New York, NY is seeking a COB Coordinator to analyze coordination of benefits and communicate with members and insurers to determine primary and secondary eligibility for spouses and dependents.

Responsibilities include reviewing COB information, updating enrollment screens in Vitech (V3), producing weekly/monthly reports in Excel, and handling inquiries from internal departments with accuracy and courtesy.

Qualifications

• High School Diploma or GED required; some college preferred.
• Minimum two years clerical experience in a general office.
• Basic skill in Microsoft Excel and Word preferred.

Responsibilities

• Analyze COB information from members and insurers to establish primary/secondary eligibility.
• Communicate via telephone with members, insurers, and professionals regarding COB inquiries.
• Respond to COB inquiries from internal Fund departments (e.g., Provider Relations, Member Services).
• Prepare and mail letters to members or employers regarding COB.
• Investigate COB eligibility when necessary.
• Update COB patient maintenance screens in the enrollment system (Vitech V3) for L fund groups.
• Prepare weekly and monthly production reports via Microsoft Excel.
• Perform additional duties and projects as assigned by management.

Skills

Communication skills

Customer service

Problem solving

Teamwork

Education

High School Diploma or GED

Tools

Microsoft Excel

Microsoft Word

Job description

Requisition #

7518

# 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

• 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 and Word 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