Telephone Representative II (Provider Relations) - 1199 SEIU Funds : Job Details

Telephone Representative II (Provider Relations)

1199 SEIU Funds

Job Location : New York,NY, USA

Posted on : 2025-08-27T15:53:37Z

Job Description :
Responsibilities
  • Communicate with doctors, hospitals, and other professionals via telephone regarding 1199SEIU members, dependent eligibility for health benefits, claims, and other plan services
  • Verify and determine eligibility for members, spouses, dependents, including the reinstatement of terminated coverage
  • Research and request documentation for provider enrollment, credentialing and provider file updates
  • Research and provide schedule of allowance for procedure codes and prior authorization requirements, research check reconciliation of claim payments
  • Accurately and professionally respond to telephone inquiries regarding member benefits and claims
  • Examine dental, vision, hospital, and medical claim histories for claim status, accuracy and timeliness
  • Create call tracking records in call tracking system (QNXT) to the appropriate call tracking folders for resolution; mail printed materials upon request
  • Review call tracking items returned to individual folder for closure or assignment to correct call tracking folder as required
  • Assign claim inquiries, enrollment, and eligibility issues to appropriate call tracking folders for resolution
  • Generate call tracking inquiries for problems related to all of the above for correction
  • Advise providers of new programs, plan improvements and plan changes
  • Verify provider inquiry using Knowledge Tool (BeneFAQs, QNXT, DocFind, iObserver)
  • Retrieve and review scanned claim images using IRIS System
  • 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 required
  • Keyboarding skills required (minimum 5,000 KPH and 80% accurate rate)
  • Experience using web-based applications, basic knowledge of health claims processing systems (QNXT, Vitech) and Fund eligibility requirements preferred (National Benefit Fund, Greater New York Fund, Home Care Fund); experience with Provider Relations a plus
  • Excellent written and verbal communication skills with great interpersonal skills
  • Ability to initiate own correspondence and maintain a pleasant attitude to ensure excellent service to members and providers
  • Ability to multi-task and work under pressure due to volume and urgent nature of calls
  • Call Center hours of operation are from 8:00 am - 6:00 pm; shifts are subject to change and/or availability
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