Maintain HIPAA compliance while communicating with 1199SEIU members and advocates via telephone or written correspondence regarding benefit eligibility and claim submissions; accurately and professionally respond to a high volume of calls and inquiries by providing excellent customer service
Respond to outbound inquiries which include voicemails and emails
Provide assistance with medical and pension benefits, Medical and Part B claims and retiree programs
Provide benefit eligibility requirements for Pension and Retiree Health Benefits to prospective pensioners and beneficiaries; research and establish eligibility for members and the reinstatement of terminated coverage;
Generate inquiries for pension applications, pension estimates, check stop payments, death e-forms and Medical Code updates
Update Member and/or Retiree demographic information (i.e. address, telephone number and email) as needed
Generate pension verification letters at member’s request and request duplicate 1099-R Tax Forms as needed
Mail requested Pension and Retiree Health information such as applications, direct deposit forms, Preferred Drug Lists, Medical & Part B Claim forms, Enrollment Change forms, explanation of benefits, directories, etc
Communicate and explain Retiree Health Benefits (RHB) to retirees (i.e., Medicare Part D and 1199SEIU Medicare Advantage Plan); alert members of new RHB programs, plan improvements or changes
Research disability and medical claim history for claim status, accuracy, and timeliness; access various web-based applications relevant to member’s inquiries
Communicate with Eligibility department via call tracking module (QNXT), e-mail to update or terminate a member’s eligibility and Medicare Part D information
Generate inquiries for health cards; request letters of Creditable Coverage when necessary; contact Medicare and Centers for Medicare & Medicaid Services (CMS) to verify member Medicare Part D eligibility
Provide assistance to members of Aetna MAPD with eligibility and benefit issues
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; or two (2) years conducting pension calculations required
Knowledge of Pension and Retiree Health Benefits provided by the Funds preferred (National Benefit Fund, Greater NY and Home Care, Hospital League, 144 Hospital Pension, etc)
Knowledge of web-based applications, health claims systems, and call tracking systems with good navigation skills (Vitech and QNXT)
Keyboarding skills required (minimum 5,000 KPH and 80% accurate rate)
Excellent customer service skills required; able to maintain pleasant and helpful demeanor ensuring professional service is provided
Superb communication skills both verbal and written; able to communicate in a clear and concise manner and initiate own correspondence
Ability to work well under pressure due to the high volume and urgent nature of calls
Able to multi-task, establish priorities, meet deadlines, and follow through on assignments
Member Services hours of operation are from 8:00 am - 6:00 pm; shifts are subject to change and/or availability
