1199SEIU Benefit and Pension Funds · 11 hours ago
Quality Control Reviewer I
New York, NY
Full-time
Hybrid
Entry Level
2+ years exp1199SEIU Benefit and Pension Funds is seeking a Quality Control Reviewer I to manage and triage daily mail intake related to appeals and inquiries. The role involves reviewing documentation, communicating with members and providers, and maintaining accurate records to ensure timely handling of assignments.
Non ProfitRetirement
Responsibilities
Review, manage and triage daily mail intake, including appeals email inbox, to ensure all necessary documentation is complete and accurate, independently determine priority and distribute appeals and inquiries to Appeals staff via Document/Appeals Management System (DMS/AMS) per existing workflow
Assist with the research of new appeals/inquiries by accessing QNX T (medical/hospital claims system, provider and V3 (Vi-Tech) to verify member’s eligibility, demographics, provider records, and claims images
Document and update accurate memos of incoming/outgoing correspondence regarding appeals and inquiries and communications in claims processing system (QNX T) and (DMS/AMS)
Maintain accurate and detailed records of mail and track assignments via tracking logs/reports, to ensure all assignments are handled timely in accordance with the departmental policies and procedures
Review and respond to provider inquiries and ensure that they are sent to the appropriate payment area for benefit reconsideration. Track and ensure completeness
Communicate with members and providers via phone and in writing, to obtain necessary information and/or address appeal related questions
Provide assistance with respective workflows to Appeal Reviewer’s
Retrieve messages from Appeals Hotline, to include callbacks, and maintain log report
Index and archive documents/files electronically in DMS/AMS
Conduct system testing as it relates to departmental system enhancements and review performance of automated software
Perform additional duties and projects assigned by management
Qualification
Required
High School Diploma or GED required
Minimum two (2) year clerical experience in a health plan environment and one (1) year customer service experience required
Knowledge of medical claims processing including major medical, office visits, surgery, anesthesia, lab and x-rays required
Knowledge of eligibility systems including Coordination of Benefits (COB) and Consolidated Omnibus Budget Reconciliation Act (COBRA) benefits required
Knowledge of QNXT claims and provider system with the ability to effectively and efficiently check medical and hospital claims history, and provider participation record required
Understanding of benefit program and eligibility guidelines, including eligibility verification, of the 1199SEIU Benefit and Pension Funds required
Excellent oral and written customer service skills and ability to maintain a pleasant attitude; provide professional and courteous service to our members
Analytical, detail-oriented, ability to work under pressure independently and as a team player; ability to prioritize, follow up and handle multiple tasks based on set timeframes, and organizational skills
Must be able to maintain the confidentiality required of the organization and the department
Must meet performance standards including attendance and punctuality
Preferred
Knowledge of web-based applications, ability to learn and use computer databases and online filing systems preferred
Intermediate skill level in Microsoft Word and Excel preferred
Company
1199SEIU Benefit and Pension Funds
The 1199SEIU Funds are among the strongest and largest labor-management funds in the nation, providing a range of comprehensive benefits to 400,000 working and retired healthcare industry workers — members of 1199SEIU United Healthcare Workers East — and their families.
1001-5000 employees
H1B Sponsorship
1199SEIU Benefit and Pension Funds has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (1)
2022 (1)
Funding
Current Stage
Late StageTotal Funding
$3.72MKey Investors
Community Development Financial Institutions Fund
2023-04-10Grant· $3.72M
Leadership Team
Donna Rey
Executive Director & CEO
Recent News
Crain's New York Business
2023-12-22
Company data provided by crunchbase