Responsibilities:
· Conduct audits of Provider Relations call center inquiries via various systems (i.
e.
Vitech, QNXT, and Call Tracking)
· Communicate with providers, collection agencies, hospitals, doctors, dentists, lawyers, employers, and other professionals regarding health claims and other benefit inquiries; provide backup coverage to Telephone Representatives as needed
· Assist Supervisor in reviewing work of call center staff and redistribute errors; provides departmental training and side-by-side mentoring of staff
· Assist Telephone Representatives with difficult calls and resolve complex problems
· Investigate issues, provider advances and assist providers with claim payments or adjustments
· Work closely with various departments, insurance carriers and other agencies to resolve issues (i.
e.
Provider Relations, Claims, Finance, Eligibility and Coordination of Benefits)
· Review eligibility and claims systems for errors and call track and/or escalate inquiries for corrections or adjustments
· Review and monitor department call tracking folder, process call tracking inquiries, identify trends and troubleshoot problems
· Access web-based or report applications relevant to provider inquiries (i.
e.
ABF, iObserver, intranet, on-demand reports, or external provider websites)
· Review and search information using knowledge tool (i.
e.
BeneFAQs)
· Must meet departmental performance standards
· 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 call center experience as a Telephone Representative in a health plan or benefits environment required
· Comprehensive knowledge of eligibility, rules for extended or limited continuation of benefits (coordination of benefits, retiree extensions, enrollment)
· Comprehensive knowledge of health benefits such as: hospital, surgical, x-ray, laboratory, major medical, etc.
· Knowledge of 1199SEIU Fund benefits preferred (National Benefit Fund, Greater New York and Home Care Fund)
· Experience navigating web based applications and Call Tracking Systems (Vitech, QNXT, iObserver and IRIS)
· Excellent communication skills (written and verbal) and interpersonal skills; ability to maintain a pleasant attitude with providers to ensure customer satisfaction
· Able to work well under pressure, multi-task, establish priorities, meet deadlines, and follow up
· Strong ability to lead, mentor and motivate others, maintain professional manner and presentation
· Good problem solver and excellent analytical skills
· Call Center hours of operation are from 8:00 am until 6:00 pm; shifts are subject to change and/or availability
· Must meet attendance and punctuality standards
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