Telephone Representative II

Job description

Responsibilities · Maintain HIPAA compliance while communicating with 1199SEIU members and advocates via telephone or written correspondence regarding benefit eligibility, claim submissions and plans, programs and services · Distinguish the benefit plans per Fund; identify their appropriate enrollment and eligibility rules and required documentation · Verify, establish and re-establish member eligibility for new or existing members, spouses and dependents using the eligibility and enrollment systems (Syntonics, QNXT, V3, and Member Portal) · Request required proof of wages or hours worked as necessary; forward documentation to the Eligibility Department to update member eligibility records · Research status of hospital and medical claim payments and benefit checks · Verify coordination of benefits with other carriers and agencies · Create call tracking records (QNXT) to assign and distribute inquiries to the appropriate departmental folders for resolution (i.e. claims, checks, Explanation of Benefits, enrollment and eligibility issues) · Compose and mail printed materials at member’s request; provide list of participating providers, Primary Care Physician’s (PCPs) and Member Choice...