Quality Control Reviewer III

1199SEIU Benefit and Pension Funds; New York (NY); On-site; USD 45,000 - 70,000; Full time

Job summary

An established industry player is seeking a detail-oriented Life Insurance Approver to ensure timely and accurate processing of claims. In this role, you will conduct audits, handle complex inquiries, and communicate effectively with beneficiaries and various professionals. The ideal candidate will possess strong communication and leadership skills, along with a solid understanding of life insurance eligibility and benefits. This position offers a unique opportunity to contribute to a vital service while working in a supportive and professional environment. If you thrive under pressure and enjoy problem-solving, this role is perfect for you.

Qualifications

• Minimum two years experience as a life insurance approver required.
• Comprehensive knowledge of life insurance eligibility and benefits required.

Responsibilities

• Conduct audits of life insurance claims to measure accuracy.
• Communicate with beneficiaries and resolve complex inquiries.

Skills

Effective communication skills

Interpersonal skills

Ability to work under pressure

Leadership ability

Education

High school diploma or GED

Some college or degree

Tools

MS Word

Excel

Job description

Responsibilities:

• ·Conduct audit of life insurance and accidental death and dismemberment claims to measure timeliness and accuracy

• ·Handle and resolve complex questions and issues, pended life insurance claims, inquiries and appeals

• ·Communicate, in person, by telephone or in writing, with beneficiaries and their representatives, attorneys, employers, funeral homes, health care providers, and other professional regarding life insurance claims

• ·Work closely with various departments to address eligibility, pension or other issues affecting life claim resolution

• ·Assist with claims referrals from life claims processors as needed

• ·Delegate staff assignments and assist in training and retraining of staff

• ·Troubleshoot problems and assist staff in resolving difficult issues, answer questions regarding policies and procedures

• ·Create and maintain various production, statistical, financial, and audit reports

• ·Assist life insurance staff members with difficult or complex calls, and walk in contacts

• ·Monitor system performance related to life claims; identify trends, review results, and provide recommendations for improvements in training, controls and procedures or system updates

• ·Assist hotline support as needed

• ·Handle assignments of burial plots using plot grids and maps

• ·Perform additional duties as assigned by management

Qualifications:

• ·High school diploma or GED required, some college or degree preferred

• ·Minimum two (2) years experience as a life insurance approver processing group life and accidental death required

• ·Comprehensive knowledge of NBF, GNY and home care funds life insurance eligibility, benefits and rules for extended or limited continuation of benefits required

• ·Experience working in MS Word and Excel preferred

• ·Effective communications skills both written and oral required

• ·Good interpersonal skills, including ability to communicate with the staff on a professional level

• ·Ability to work under pressure and independently

• ·Leadership ability including professional manner and presentation

• Must meet quality and production standards set by the department