ResponsibilitiesCommunicate with doctors, hospitals, and other professionals via telephone regarding 1199SEIU members, dependent eligibility for health benefits, claims, and other plan servicesVerify and determine eligibility for members, spouses, dependents, including the reinstatement of terminated coverageResearch and request documentation for provider enrollment, credentialing and provider file updatesResearch and provide schedule of allowance for procedure codes and prior authorization requirements; research check reconciliation of claim paymentsAccurately and professionally respond to telephone inquiries regarding member benefits and claimsExamine dental, vision, hospital, and medical claim histories for claim status, accuracy and timelinessCreate call tracking records in call tracking system (QNXT) to the appropriate call tracking folders for resolution; mail printed materials upon requestReview call tracking items returned to individual folder for closure or assignment to correct call tracking folder as requiredAssign claim inquiries, enrollment, and eligibility issues to appropriate call tracking folders for resolutionGenerate call tracking inquiries for problems related to all of the above for correctionAdvise providers of new programs, plan improvements and plan changesVerify provider inquiry using Knowledge Tool (BeneFAQs, QNXT, DocFind, iObserver)Retrieve and review scanned claim images using IRIS SystemPerform additional duties and projects as assigned by management QualificationsHigh School Diploma or GED required; Some College or Degree preferredMinimum two (2) years high volume customer service experience in a call center environment; or two (2) years healthclaims processing experience requiredKeyboarding Skills required (minimum 6,000 KPH and 6% or less error 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 plusExcellent written and verbal communication skills with great interpersonal skillsAbility to initiate own correspondence and maintain a pleasant attitude to ensure excellent service to members and providersAbility to multi-task and work under pressure due to volume and urgent nature of callsCall Center hours of operation are from 8:00 am 6:00 pm; shifts are subject to change and/or availability