1199SEIU Benefit and Pension Funds
Telephone Representative II (Provider Relations)
1199SEIU Benefit and Pension Funds, New York, New York, us, 10261
Telephone Representative II (Provider Relations)
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Telephone Representative II (Provider Relations)
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Telephone Representative II (Provider Relations)
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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
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Join to apply for the
Telephone Representative II (Provider Relations)
role at
1199SEIU Benefit and Pension Funds Continue with Google Continue with Google 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 Referrals increase your chances of interviewing at 1199SEIU Benefit and Pension Funds by 2x Get notified about new Representative jobs in
New York, NY . Manhattan, NY $40,000 - $42,000 1 month ago Mid-Market Account Executive - Talent & Learning
New York, NY $100,000 - $120,000 1 week ago New York, NY $60,000 - $64,350 2 weeks ago Account Executive - Sephora, Long Island
New York, NY $95,000.00 - $114,000.00 4 days ago New York, NY $100,000.00 - $120,000.00 1 week ago New York, NY $85,000.00 - $95,000.00 4 weeks ago New York, NY $75,000.00 - $85,000.00 1 month ago New York, NY $80,000.00 - $100,000.00 1 month ago New York City Metropolitan Area $80,000.00 - $100,000.00 2 weeks ago Mid-Market Account Executive, Search & Staffing - Talent Solutions
New York, NY $125,000.00 - $180,000.00 1 week ago New York, NY $30,000.00 - $50,000.00 3 months ago Manhattan, NY $129,000.00 - $206,000.00 1 week ago New York, NY $185,000.00 - $340,000.00 3 days ago FULL TIME Assistant Manager- $22.50 an hour with Free Movies
New York, NY $60,000.00 - $65,000.00 2 weeks ago Account Executive, Field Sales & Training - Northeast (ULTA)
New York, NY $70,000.00 - $85,000.00 2 months ago Brooklyn, NY $129,000.00 - $206,000.00 4 days ago Elizabeth, NJ $129,000.00 - $206,000.00 4 days ago New York, NY $85,000 - $115,000 2 weeks ago Sales & Education, Account Executive - NYC
New York, NY $108,200 - $132,200 3 days ago Account Executive 3, Online Sales, Marketing Solutions
New York, NY $88,000 - $126,000 1 week ago Were unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI. #J-18808-Ljbffr