Quality Control Reviewer I

Responsibilities

 

·        Analyze Coordination of Benefits (COB) information received from members and other insurance companies to establish primary and secondary eligibility for spouse and dependents

·        Communicate via telephone with members, insurance carriers, and other professionals regarding COB inquires

·        Respond to inquiries regarding COB from departments within the Fund (i.e. Provider Relations, Member Services)

·        Prepare and mail letters to members and/or employers regarding the Coordination of Benefits

·        Conduct investigation, when necessary, in determining (COB) eligibility

·        Update COB patient maintenance screens and other applicable screens in the enrollment processing system Vitech (V3) for the National Benefit Fund, Greater and New York Benefit Fund

·        Prepare weekly and monthly production reports via Microsoft Excel

·        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 relevant clerical experience in a general office environment required; high volume telephone customer service experience preferred

·        Basic skill level in Microsoft Excel and Word preferred

·        Knowledge of all Funds (NBF, GNY, GNJ) eligibility criteria

·        Knowledge of eligibility systems and COB guidelines

·        Excellent oral and written communication skills; ability to speak in a clear and concise manner

·        Excellent customer service skills and ability to maintain a pleasant attitude; provide professional and courteous service to members

·        Ability to prioritize work with tight schedules and target dates

·        Problem solver with ability to work independently and as a team player

·        Available to work overtime including Saturdays preferred

·        Must meet performance standards including attendance and punctuality