Quality Control Reviewer II

Job Title

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;

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