Quality Control Reviewer III

1199SEIU Benefit and Pension Funds; New York (NY); Hybrid; USD 40,000 - 79,000; Full time

Job summary

A leading organization in the health care sector is seeking a Quality Control Reviewer III. The role involves assisting retirees with inquiries, reviewing pension applications, and ensuring compliance with eligibility guidelines. Candidates should possess strong communication skills and experience in a call center environment. This is a full-time, permanent position with a hybrid work arrangement, offering a supportive work culture and opportunities for professional growth.

Qualifications

• Minimum two years’ experience in a high-volume call center required.
• Knowledge of 1199SEIU Benefit and Pension Fund eligibility guidelines.

Responsibilities

• Greet and assist retirees over the phone and via email.
• Review and verify submitted Pension applications and forms.
• Communicate with members regarding claims and inquiries.

Skills

Communication

Interpersonal Skills

Multi-tasking

Education

High School Diploma or GED

Some College or Degree

Tools

Microsoft Outlook

Microsoft Excel

Microsoft Word

Call Tracking Systems

Eligibility Systems

Web-based Applications

Job description

Join to apply for the Quality Control Reviewer III role at 1199SEIU Benefit and Pension Funds

1 week ago Be among the first 25 applicants

Join to apply for the Quality Control Reviewer III role at 1199SEIU Benefit and Pension Funds

• Greet and assist retirees over the phone and via email; review and validate member demographics against database to measure system accuracy.
• Assist 1199SEIU retired members with inquiries regarding Retiree Health and Pension Benefit eligibility and payment status.
• Review and verify submitted Pension applications and forms ensuring all required documentation is provided and complete
• Explain application process and assist members with enrollment for the 1199SEIU Medicare Advantage Plan or Medicare Part D; assist members with Aetna MAPD enrollment
• Schedule interviews with prospective pensioners; update members with status of pension applications
• Communicate with members, via telephone and/or email regarding claims and other benefit related inquiries; provide support to Telephone Representatives as needed.
• Troubleshoot problems, assist members/retirees in resolving difficult and complex issues related to pension, claims, retiree benefits and payments, answer questions regarding policies, retiree programs and service.
• Partner with various departments (i.e.: Eligibility, Medical Claims and Pension) to resolve member inquiries.
• Compose verification letters, generate duplicate 1099R tax forms, explanation of benefits and health identification cards at members’ request; request letters of Creditable Coverage as needed.
• Access web-based applications relevant to inquiries (i.e.: V3, QNXT, Superscreen, BeneFaqs, Medco, iObserver, DocFind, etc.)
• Perform additional duties and projects as assigned by management.
  
  

Requisition #:

7210

# 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

• Greet and assist retirees over the phone and via email; review and validate member demographics against database to measure system accuracy.
• Assist 1199SEIU retired members with inquiries regarding Retiree Health and Pension Benefit eligibility and payment status.
• Review and verify submitted Pension applications and forms ensuring all required documentation is provided and complete
• Explain application process and assist members with enrollment for the 1199SEIU Medicare Advantage Plan or Medicare Part D; assist members with Aetna MAPD enrollment
• Schedule interviews with prospective pensioners; update members with status of pension applications
• Communicate with members, via telephone and/or email regarding claims and other benefit related inquiries; provide support to Telephone Representatives as needed.
• Troubleshoot problems, assist members/retirees in resolving difficult and complex issues related to pension, claims, retiree benefits and payments, answer questions regarding policies, retiree programs and service.
• Partner with various departments (i.e.: Eligibility, Medical Claims and Pension) to resolve member inquiries.
• Compose verification letters, generate duplicate 1099R tax forms, explanation of benefits and health identification cards at members’ request; request letters of Creditable Coverage as needed.
• Access web-based applications relevant to inquiries (i.e.: V3, QNXT, Superscreen, BeneFaqs, Medco, iObserver, DocFind, etc.)
• 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’ experience in a high-volume call center as a Telephone Representative in a health insurance or benefits environment required.
• Knowledge of 1199SEIU Benefit and Pension Fund eligibility guidelines, benefit entitlements, and plan rules for multiple Funds (Greater NY Benefit Fund, Home Care Employees Pension Fund and National Benefit Fund).
• Knowledge of pension operations and systems (Eligibility, Disability, Medical, Pension, etc.) required.
• Knowledge of call tracking systems, eligibility systems and all web-based applications (i.e: V3, Iris, iObserver and QNXT); basic knowledge of Microsoft Outlook, Excel and Word preferred.
• Excellent communication skills – oral, written and listening; excellent interpersonal skills including courtesy, tact and discretion.
• Ability to maintain a professional manner; ability to maintain a pleasant attitude to ensure excellent service to
• Able to work well under pressure, multi-task, establish priorities, meet deadlines and follow through on assignments.
• Able to provide coverage at front windows and/or satellite offices due to operational needs.
• Call Center hours of operation are from 8:00am – 6:00pm; shifts are subject to change and/or availability.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Administrative

• Industries

  Hospitals and Health Care

Referrals increase your chances of interviewing at 1199SEIU Benefit and Pension Funds by 2x

Get notified about new Reviewer jobs in New York, NY.

Manhattan, NY $40,957.00-$47,100.00 3 months ago

New York, NY $42,485.00-$48,858.00 1 day ago

New York City Metropolitan Area $53,000.00-$80,000.00 2 weeks ago

New York, NY $57,976.00-$66,672.00 6 hours ago

Brooklyn, NY $65,000.00-$70,000.00 2 weeks ago

Counterparty Risk Reviewer/Audit (Max $60/hr W2)

New York, NY $70,000.00-$78,000.00 1 week ago

New York City Metropolitan Area 2 weeks ago

Brooklyn, NY $42,485.00-$48,858.00 1 day ago

Business Writer - Relocate to Saudi Arabia

We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.