Quality Control Reviewer I

Job TitleAnalyze Coordination of Benefits (COB) information received from members and other insurance companies to establish primary and secondary eligibility for spouse and dependentsCommunicate via telephone with members, insurance carriers, and other professionals regarding COB inquiresRespond 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 BenefitsConduct investigation, when necessary, in determining (COB) eligibilityUpdate 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 FundPrepare weekly and monthly production reports via Microsoft ExcelPerform additional duties and projects as assigned by managementHigh School Diploma or GED required, some College or Degree preferredMinimum two (2) years relevant clerical experience in a general office environment required; high volume telephone customer service experience preferredBasic skill level in Microsoft Excel and Word preferredKnowledge of all Funds (NBF, GNY, GNJ) eligibility criteriaKnowledge of eligibility systems and COB guidelinesExcellent oral and written communication skills; ability to speak in a clear and concise mannerExcellent customer service skills and ability to maintain a pleasant attitude; provide professional and courteous service to membersAbility to prioritize work with tight schedules and target datesProblem solver with ability to work independently and as a team playerAvailable to work overtime including Saturdays preferredMust meet performance standards including attendance and punctuality