Telephone Representative II (Member Services)
1199SEIU Family of Funds - New York, NY

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  • Communicate with 1199SEIU members and advocates via telephone or written correspondence regarding benefit eligibility, claim submissions and plans, programs and services
  • Distinguish the benefit plans per Fund; identify their appropriate enrollment and eligibility rules and required documentation
  • Verify, establish and re-establish member eligibility for new or existing members, spouses and dependents using the eligibility and enrollment systems (Syntonics, QNXT, V3, and Member Portal)
  • Request required proof of wages or hours worked as necessary; forward documentation to the Eligibility Department to update member eligibility records
  • Research status of hospital and medical claim payments and benefit checks
  • Verify coordination of benefits with other carriers and agencies
  • Create call tracking records (QNXT) to assign and distribute inquiries to the appropriate departmental folders for resolution (i.e. claims, checks, Explanation of Benefits, enrollment and eligibility issues)
  • Compose and mail printed materials at member’s request; provide list of participating providers, Primary Care Physician’s (PCPs) and Member Choice Networks
  • Alert members of new plan changes, plan improvements, or special event dates and locations
  • Access web-based applications relevant to member inquiries (iObserver, Medco, IRIS, Super Screen)
  • Perform additional duties and projects as assigned by management

  • High School Diploma or GED required, some College or Degree preferred
  • Minimum two (2) years high volume customer service experience in a call center environment; or two (2) years health claims processing experience required
  • Experience with Member Services in a Health Insurance or benefits environment highly preferred
  • Knowledge of health claims processing systems (QNXT, Syntonics, V3) and Fund eligibility requirements preferred (1199SEIU National Benefit Fund, Greater New York Fund, Home Care Fund, Home Health Aide Fund)
  • Excellent written and verbal communication skills with great interpersonal skills
  • Able to initiate correspondence and maintain a pleasant attitude to ensure excellent service to members and providers
  • Ability to work well under pressure due to the high volume and urgent nature of calls
  • Member Services hours of operation are from 8:00 am until 6:00 pm; shifts are subject to change and/or availability
  • Must meet performance standards including attendance and punctuality