Senior Quality Assurance Auditor – Provider Claims

1199seiubenefits; New York (NY); On-site; USD 42,000 - 62,000; Full time

Job summary

1199SEIU Benefits is seeking a Provider Relations Call Center Associate to audit inquiries across Vitech, QNXT, and Call Tracking systems, ensuring accurate resolution of health claim and benefit questions. You will interact with providers, hospitals, and other professionals, support supervisors, mentor staff, and help improve departmental processes while meeting performance standards.

Required: high school diploma, 2+ years in a high-volume health plan call center, strong communication and

Qualifications

• High School Diploma or GED required; some college or degree preferred.
• Minimum two years of high-volume call center experience in a health plan or benefits environment.
• Knowledge of eligibility rules for extended or COB benefits.
• Knowledge of health benefits such as hospital, surgical, and lab services.
• Familiarity with 1199SEIU Fund benefits (national and NY files) preferred.
• Experience navigating web-based applications and call tracking systems.
• Excellent communication and interpersonal skills; ability to maintain a pleasant attitude with providers.
• Able to work under pressure, multi-task, set priorities, meet deadlines, and follow up.
• Strong leadership, mentoring, and motivational skills.
• Call Center hours are 8:00 am–6:00 pm; shifts subject to change.

Responsibilities

• Audit audits of Provider Relations call center inquiries using systems like Vitech, QNXT, and Call Tracking.
• Communicate with providers, collection agencies, hospitals, doctors, dentists, lawyers, and employers regarding health claims and benefits inquiries; provide backup coverage as needed.
• Assist Supervisor in reviewing work, redistribute errors, and provide departmental training and mentoring.
• Assist Telephone Representatives with difficult calls and resolve complex problems.
• Investigate issues, provider advances, and assist with claim payments or adjustments.
• Collaborate with Provider Relations, Claims, Finance, Eligibility and COB teams to resolve issues.
• Review eligibility and claims systems for errors and route inquiries for corrections.
• Monitor the department call tracking folder and process inquiries; identify trends and troubleshoot.
• Access web-based or report applications relevant to provider inquiries (ABF, iObserver, intranet, on-demand reports, external provider sites).
• Review and search information using knowledge tools (BeneFAQs).
• Must meet departmental performance standards.
• Perform additional duties and projects as assigned by management.

Skills

Excellent communication

Mentoring

Multi-tasking

Interpersonal skills

Attention to detail

Education

High School Diploma or GED

Some College or Degree preferred

Tools

Vitech

QNXT

iObserver

IRIS

Job description

1199SEIU Benefits is seeking a Provider Relations Call Center Associate to audit inquiries across Vitech, QNXT, and Call Tracking systems, ensuring accurate resolution of health claim and benefit questions. You will interact with providers, hospitals, and other professionals, support supervisors, mentor staff, and help improve departmental processes while meeting performance standards.

Required: high school diploma, 2+ years in a high-volume health plan call center, strong communication and