Job Description

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