Quality Control Reviewer III

1199SEIU Benefit and Pension Funds; New York (NY); On-site; USD 40,000 - 70,000; Full time

Job summary

An established industry player is seeking a dedicated Telephone Representative to provide exceptional support to retirees regarding their health and pension benefits. In this role, you will engage with members over the phone and via email, ensuring their inquiries are handled with care and efficiency. You will play a crucial role in verifying applications, explaining processes, and troubleshooting complex issues. If you thrive in a fast-paced environment and possess excellent communication skills, this opportunity is perfect for you to make a significant impact on the lives of retirees.

Qualifications

• Minimum 2 years in a high-volume call center, preferably in health insurance.
• Knowledge of 1199SEIU Benefit and Pension Fund eligibility guidelines.

Responsibilities

• Assist retirees with inquiries regarding health and pension benefits.
• Review and verify pension applications and documentation.

Skills

Communication Skills

Problem-Solving

Interpersonal Skills

Multi-tasking

Education

High School Diploma or GED

Some College or Degree

Tools

V3

QNXT

Microsoft Outlook

Microsoft Excel

Microsoft Word

Job description

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 members.
• 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.