Quality Control Reviewer I

Responsibilities

· Analyze Coordination of Benefits (COB) information received from members and other insurance companies to establish primary and secondary eligibility for spouse and dependents · Communicate via telephone with members, insurance carriers, and other professionals regarding COB inquires · Respond to inquiries regarding COB from departments within the Fund (i.e. Provider Relations, Member Services) · Prepare and mail letters to members and/or employers regarding the Coordination of Benefits · Conduct investigation, when necessary, in determining (COB) eligibility · Update COB patient maintenance screens and other applicable screens in the enrollment processing system Vitech (V3) for the National Benefit Fund, Greater and New York Benefit Fund · Prepare weekly and monthly production reports via Microsoft Excel · 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 relevant clerical experience in a general office environment required; high volume telephone customer service experience preferred · Basic skill level in Microsoft Excel and Word preferred · Knowledge of all Funds (NBF, GNY, GNJ) eligibility criteria · Knowledge of eligibility systems and COB guidelines · Excellent oral and written communication skills; ability to speak in a clear and concise manner · Excellent customer service skills and ability to maintain a pleasant attitude; provide professional and courteous service to members · Ability to prioritize work with tight schedules and target dates · Problem solver with ability to work independently and as a team player · Available to work overtime including Saturdays preferred · Must meet performance standards including attendance and punctuality