• Job Description

  Req#: 10858

  Responsibilities

  • Maintain HIPAA compliance while communicating with 1199SEIU members and advocates via telephone or written correspondence regarding benefit eligibility and claim submissions; accurately and professionally respond to a high volume of calls and inquiries by providing excellent customer service
  • Respond to outbound inquiries which include voicemails and emails
  • Provide assistance with medical and pension benefits, Medical and Part B claims and retiree programs
  • Provide benefit eligibility requirements for Pension and Retiree Health Benefits to prospective pensioners and beneficiaries; research and establish eligibility for members and the reinstatement of terminated coverage;
  • Generate inquiries for pension applications, pension estimates, check stop payments, death e-forms and Medical Code updates
  • Update Member and/or Retiree demographic information (i.e. address, telephone number and email) as needed
  • Generate pension verification letters at member’s request and request duplicate 1099-R Tax Forms as needed
  • Mail requested Pension and Retiree Health information such as applications, direct deposit forms, Preferred Drug Lists, Medical & Part B Claim forms, Enrollment Change forms, explanation of benefits, directories, etc
  • Communicate and explain Retiree Health Benefits (RHB) to retirees (i.e., Medicare Part D and 1199SEIU Medicare Advantage Plan); alert members of new RHB programs, plan improvements or changes
  • Research disability and medical claim history for claim status, accuracy, and timeliness; access various web-based applications relevant to member’s inquiries
  • Communicate with Eligibility department via call tracking module (QNXT), e-mail to update or terminate a member’s eligibility and Medicare Part D information
  • Generate inquiries for health cards; request letters of Creditable Coverage when necessary; contact Medicare and Centers for Medicare & Medicaid Services (CMS) to verify member Medicare Part D eligibility
  • Provide assistance to members of Aetna MAPD with eligibility and benefit issues
  • 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 high volume customer service experience in a call center environment; or two (2) years health claims processing experience; or two (2) years conducting pension calculations required
  • Knowledge of Pension and Retiree Health Benefits provided by the Funds preferred (National Benefit Fund, Greater NY and Home Care, Hospital League, 144 Hospital Pension, etc)
  • Knowledge of web-based applications, health claims systems, and call tracking systems with good navigation skills (Vitech and QNXT)
  • Keyboarding skills required (minimum 5,000 KPH and 80% accurate rate)
  • Excellent customer service skills required; able to maintain pleasant and helpful demeanor ensuring professional service is provided
  • Superb communication skills both verbal and written; able to communicate in a clear and concise manner and initiate own correspondence
  • Ability to work well under pressure due to the high volume and urgent nature of calls
  • Able to multi-task, establish priorities, meet deadlines, and follow through on assignments
  • Member Services hours of operation are from 8:00 am - 6:00 pm; shifts are subject to change and/or availability

• About the company

  Providing healthcare, pension, financial and social services, training, child care and more to 1199SEIU members. Contact us at (646) 473-9200.

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