Eligibility Coordinator

Job Title

Responsibilities

• Liaison between members, staff, and eligibility department to resolve hotline eligibility and enrollment matters at the 1199SEIU Benefit and Pension Funds

• Resolve issues related to QNXT system, Call Tracking Report, QNXT Discrepancy Report, QNXT Discrepancy file for Medical Department and QNXT Alternate Payee requests.

• Resolve issues related to DMS, Member Portal system, Member mobile application, workflows, TPA external eligibility exception reports and discrepancies.

• Ensure member eligibility issues for active working members and retirees are resolved and benefits accurately processed in the eligibility system timely.

• Ensure HCRA monthly member exceptions are reviewed and processed in the eligibility system timely, tracking and reporting.

• Resolve QNXT eligibility inquiries, QNXT Discrepancies, QNXT Alternate Payee requests timely and the nightly/daily eligibility batch exception reports, daily Executive Lives report and BI unit exception control reports.

• Resolve and respond to JSF, CCF, TEF and Retiree Health Benefit inquiries – including tracking of unresolved issues, communicate with various department and members to ensure benefit enrollment updates are processed timely, accurately, and efficiently.

• Process and update Qualifying Medical Support Court Orders in a timely and confidential matter; handle Medicare secondary payer inquiries, accurately review and process member social security merge requests.

• Review and process Pension Eligibility Valuation reports

• Review and resolve newborn reports to ensure benefits for newborns are processed accurately in eligibility system and appropriate member follow-up notifications mailed timely.

• Perform additional duties and projects as assigned by management.

Qualifications

• High School Diploma required; College Degree a plus.

• Minimum three (3) years Hotline Support experience in eligibility and three (3) year experience resolving eligibility matters and updating eligibility systems (Contribution Administration System, Vitech, QNXT and Pharmacy Benefits Manager system) required.

• Intermediate skill level in Microsoft Excel, Outlook and Word required.

• Good knowledge of 1199SEIU eligibility benefits for all Funds (i.e., National Benefit Fund, Greater New York, and Homecare)

• Excellent customer service skills a must; able to maintain a pleasant and helpful demeanor.

• Excellent oral and written communication skills and ability to speak in a clear and concise manner.

• Ability to multi-task, prioritize work with tight schedules and target dates.

• Demonstrated organizational skills with ability to multitask and follow up.

• Good problem solver with ability to work independently and as a team player.