Quality Control Reviewer II

Responsibilities

• Research and determine COBRA eligibility for members, spouses, and dependents of the 1199SEIU Benefit & Pension Funds
• Review and process COBRA benefits via the eligibility and enrollment system (V3)
• Communicate with members and other professionals via telephone or written correspondence regarding COBRA eligibility and COBRA benefit related issues
• Assist Member Service Front Window staff with COBRA member inquiries
• Process COBRA election forms and create invoices based on eligibility and billing to members including - processing of refunds and adjustments
• Import payments to COBRA payment application to update coverage
• Create prescription (RX) record and maintain eligibility according to COBRA payments
• Identify trends and work with various departments to troubleshoot issues
• Perform additional duties and projects as assigned by management
• Research member’s record and forward information to various internal/external areas for update of coverage and creation of COBRA application if required
• Investigate and process COBRA adjustments and/or refunds based on eligibility review

Qualifications

• High School Diploma or GED required, some College or Degree preferred; plus
• Minimum two (2) years’ experience in Eligibility, COBRA, or customer service required
• Knowledge of COBRA laws and eligibility rules and regulations, benefit entitlement and plan rules for multiple funds (i.e. National Benefit Fund, Greater NY/NJ, Homecare and Home Health Aid)
• Basic skill level of Microsoft Word and Excel preferred
• Able to work well under pressure, multi-task, establish priorities, meet deadlines, and follow through on assignments
• Excellent customer service skills: ability to maintain professional manner and a pleasant attitude
• Good interpersonal and communication skills; work well independently and as a team player
• Good problem solver with excellent analytical and organizational skills
• Must meet performance standards including attendance and punctuality