Telephone Representative II (Provider Relations)
Join to apply for the Telephone Representative II (Provider Relations) role at 1199SEIU Benefit and Pension Funds
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Telephone Representative II (Provider Relations)
Join to apply for the Telephone Representative II (Provider Relations) role at 1199SEIU Benefit and Pension Funds
- 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
Requisition #: 7234-7237 # of openings: 4 Employment Type Full time Position Status Permanent Category Bargaining Workplace Arrangement Hybrid Fund 1199SEIU National Benefit Fund Job Classification Non-Exempt 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
Seniority level
- Seniority level Entry level
Employment type
- Employment type Full-time
Job function
- Job function Other
- Industries Hospitals and Health Care
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