Quality Control Reviewer III

Responsibilities

• Examine and analyze eligibility vendor files and exception reports (i.e. AETNA,.)
• Assist model office as backup to review member eligibility and process daily PFL reports; addressing and resolving complex questions and issues when needed.
• Update V3 member enrollment with information based on Pension Valuation Report.
• Update V3 system with information from the reports provided by Job Security Fund (JSF) .
• Review and perform necessary updates in V3 based on exception reports generated from the Nightly Eligibility Batch and Quality Control Reports such as Eligibility Control reports, Mass Suspension, Employer Reports, System Discrepancy Reports and Disability Member Contract Batch report.
• Report data discrepancies via email with necessary departments for V3 update (i.e. DBL Dept, Elig-Staff Inquiry, COBRA, HLS & ESU)
• Identify and inform management of any high-level systemic trends and/or system issues that prevents the V3 system from determining the correct level of member eligibility
• Prepare production reports on a daily, weekly, and monthly basis.
• Collect data for reports, record trends, and provide support to the Business Analyst Unit.
• Perform other duties and assignments as directed by management

 Qualifications

• High School Diploma or GED required; some College or Degree preferred
• Minimum of two (2) years Eligibility Department experience handling and updating eligibility system (Vitech) in a health benefits environment required; Or minimum two (2) years Eligibility Data Entry experience with comprehensive knowledge of enrollment documents, eligibility requirements, benefit provisions and enrollment processing required.
• Basic skill level in Microsoft Outlook and Word preferred, Microsoft Excel required; able to perform enrollment data entry analysis and navigate eligibility systems (an)
• Knowledge of all types of extended coverage (i.e. Disability Benefits, Family Medical Leave Act (FMLA) Paid Family Leave (PFL), Job Security (JSF) and Worker’s Compensation)
• Knowledge of V3 Eligibility processing systems (Demographics, Employment, Work History, Claim History & Eligibility screens)
• Must possess excellent (oral and written) communication and interpersonal skills
• Quick-learner and eager to learn new knowledge and skills
• Good problem solver: attention to detail, the ability to analyze, and resolve problems by choosing the most practical solution
• Ability to work well under pressure, meet deadlines, and follow through on assignments
• Ability to work overtime on weekdays and Saturdays
• Must meet performance standards including attendance and punctuality