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[null,"Position Descriptions"]
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[null,"Survey Job Code","Position Title","Family Name","Position Description","B - Description and Title Change\nC - Position Code Change\nD - Description Change \nN - New Position\nS - Single Incumbent\nT - Title Change","Health Plan Executives"]
[null,"1003","President/Chief Executive Officer (CEO)","Senior Governing Executives","Responsible for directing the overall operation of a health insurance/managed care organization. Develops and implements corporate policies and procedures and establishes short- and long-range goals, objectives, and plans. Reports to the Board of Directors. Note: This is generally a single incumbent position.","S","●"]
[null,"1005","President/Chief Executive Officer (CEO) - Subsidiary","Senior Governing Executives","Responsible for directing the overall operation for a subsidiary of a health insurance/managed care organization. Develops and implements corporate policies and procedures and establishes short- and long-range goals, objectives, and plans. Frequently reports to a Chief Executive Officer or Chief Operating Officer of a parent organization.",null,"●"]
[null,"1008","Regional Executive Officer","Senior Governing Executives","Responsible for directing the regional operations of a health insurance/managed care organization including developing and implementing policies and procedures, short- and long-term goals, objectives, and plans. Typically reports to a Segment or Group President or President/Chief Executive Officer (CEO).",null,"●"]
[null,"1010","Chief Operating Officer (COO)","Corporate Support","Responsible for the daily management and coordination of the overall operation of the organization. Assumes an active role in the development and implementation of long-range plans, goals, and objectives for the organization. Reports to the President/Chief Executive Officer (CEO) and typically assumes responsibility for administration in his/her absence. Note: This is generally a single incumbent position.","S","●"]
[null,"1020","Chief Administrative Executive (CAO)","Corporate Support","Responsible for the direction and coordination of two or more administrative/staff functions; such as finance, marketing, human resources, public relations, IT, and quality assurance. Typically reports to the Chief Operating Officer (COO) or the President/Chief Executive Officer (CEO). Note: This is generally a single incumbent position.","S","●"]
[null,"1025","CEO Chief of Staff","Corporate Support","Directs, monitors, and contributes to special/strategic projects under the direction of the Chief Executive Officer (CEO). These projects are strategic in nature, highly complex, and involve creation and oversight of multifaceted teams. Advises, supports, assists, coordinates, and collaborates on special/strategic projects for the Chief Executive Officer (CEO). Organizes, problem solves, raises issues, and integrates initiatives, solutions, and actions for the Chief Executive Officer (CEO). Acts as an executive liaison to resolve problems and ensure successful implementation of company initiatives. In some organizations, this incumbent may change when the Chief Executive Officer (CEO) incumbent changes. Requires a minimum of a Bachelor's degree with at least seven years of managed care or health care experience. Note: This is generally a single incumbent position.","S","●"]
[null,"1040","Top Facilities Executive","Corporate Support","Responsible for the development of long-range objectives and policies for the maintenance and construction of the organization's facilities. May provide guidance to facilities' executives. Assists in development of the organization's policies and procedures. Typically reports to Chief Financial Officer (CFO), Top Human Resources Executive, or Top Administrative Services Executive. Note: This is generally a single incumbent position.","S","●"]
[null,"1050","Chief Financial Officer (CFO)","Finance","Responsible for overseeing all financial functions of the organization and its individual operating units. Reviews and/or establishes policies and procedures related to its accounting practices. Directs all fiscal activities such as accounting, budgets, audits, taxes, and the preparation of regulatory and government agency reports. Typically assumes responsibility for underwriting and actuarial functions. Typically reports to the President/Chief Executive Officer (CEO). Note: This is generally a single incumbent position.","S","●"]
[null,"1052","Chief Financial Officer (CFO) - Subsidiary","Finance","Responsible for overseeing all financial functions for a subsidiary of a health insurance/managed care organization. Reviews and/or establishes policies and procedures related to the subsidiary's accounting practices. Directs all its fiscal activities such as accounting, budgets, audits, taxes, and the preparation of regulatory and government agency reports. Typically reports to the President/Chief Executive Officer (CEO) - Subsidiary.",null,"●"]
[null,"1053","2nd Level Finance Executive","Finance","Ensures financial policies and plans created by the Chief Financial Officer are being implemented effectively. May be responsible for providing direction for the following functions: accounting, tax, insurance, budget, credit and/or treasury functions. Typically reports to the Chief Financial Officer (CFO). (If incumbent is acting as Controller, please match to position 1060 - Controller. If incumbent is acting as the Treasurer, please match to position 1065 - Treasurer.",null,"●"]
[null,"1055","Top Regional/Segment Finance Executive","Finance","Responsible for the financial functions of regional or segment operations. Reviews and/or establishes policies and procedures related to the organization's accounting practices within a region. Directs all regional fiscal activities such as accounting, budgets, audits, taxes, and the preparation of regulatory and government agency reports. Typically reports to Chief Financial Officer (CFO) or Regional/Segment Executive Officer - Health Plans.",null,"●"]
[null,"1057","Top Corporate Tax Executive","Finance","Responsible for developing organization tax strategy and administering tax affairs so they are in compliance with federal, state, and/or local tax laws. Responsible for filing federal and state income, ad valorem, franchise, and other taxes. Responsible for the supervision of the tax staff. Frequently reports to a Chief Financial Officer. Note: This is generally a single incumbent position. Only one employee, the most senior individual, per organization entity should be reported.","S","●"]
[null,"1060","Controller","Finance","Responsible for the development, implementation, and maintenance of the accounting systems in order to control the organization's assets and provide complete and accurate financial information/records. Prepares reports for use by top management to appraise operating results in terms of costs, budgets, trends, etc. Typically reports to the Chief Financial Officer (CFO). Note: This is generally a single incumbent position.","S","●"]
[null,"1065","Treasurer","Finance","Responsible for the direction and management of the treasury activities of the total organization. Ensures that financial transactions, policies, and procedures meet the organization's objectives, needs, and regulatory body requirements. Plans short-term financing; negotiates, administers, and repays loans; maintains cash management programs; conducts financial feasibility studies; and prepares annual financial reports. Typically reports to the Chief Financial Officer (CFO). Note: This is generally a single incumbent position.","S","●"]
[null,"1068","Top Risk Management","Finance","Responsible for a strategic risk management to help the company mitigate risks, and builds shareholder value with a full understanding of positive and negative potential of all the risks involved. Advises senior management on how to balance the organization's identified and quantified risks. Creates a risk-aware culture in the organization, and externally, familiarizes shareholders, regulators and rating agencies with the risk management program. May report to CFO, COO, or CEO. Note: This is generally a single incumbent position.","S","●"]
[null,"1070","Corporate Board Secretary","Legal/Compliance","Responsible for preparing and maintaining official corporate records, notices, and actions as required by federal, state, and local jurisdictions and by other regulatory authorities. Specific responsibilities include preparation of board agenda information packages for board members, maintaining official corporate board and committee minutes, maintaining stockholder lists and relations with registrar and transfer agent, and responding to routine inquiries from security holders. May also include shareholder relations. Typically reports to a Top Legal Executive. Note: This is an officer position. Employee must possess a law degree. If employee is also Chief Legal Officer, report under Top Legal Executive. This is generally a single incumbent position.","S","●"]
[null,"1100","Top Legal Executive","Legal/Compliance","Responsible for ensuring that corporate policies, procedures, programs, and contracts are in compliance with federal, state, and local laws and regulations. Provides advice and counsel on a variety of legal matters or problems involving the organization. Represents the organization to the courts and government agencies with regard to complex legal problems. Functions as a liaison with outside counsel regarding litigation affecting the organization and its operating units. Requires a law degree. Typically reports to the President/Chief Executive Officer (CEO). Note: This is generally a single incumbent position.","S","●"]
[null,"1102","Deputy Legal Counsel","Legal/Compliance","Reports directly to the Top Legal Executive and may perform the Top Legal Executive's duties in his/her absence. Assists with the development of legal policies and procedures. May have primary responsibility for a major legal function or department such as Corporate Tax, Intellectual Property, ERISA/Benefits, or other areas.",null,"●"]
[null,"1103","Associate General Counsel","Legal/Compliance","Responsible for a major legal specialization such as acquisitions and mergers, securities, anti-trust investigations, litigation, and taxation. Responsible for advising members within a specialized legal area or particular business activity and provides counsel in cases of litigation. Protects the organization's rights in contract negotiations, settlements, and litigation. Ensures compliance of laws and regulations. Advises management on recent changes in laws and regulations that affect the company. May direct activities of one or more General Attorneys. Typically reports to the Top Legal Executive.",null,"●"]
[null,"1105","Top Compliance Officer","Legal/Compliance","Responsible for the development, implementation, and enforcement of the compliance program. Consults on an ongoing basis on related issues with operations managers and executives. Ensures conformance with applicable laws, regulations, and accreditation standards. May or may not have a Law degree. Typically reports to Top Legal Executive. Note: This is generally a single incumbent position.","S","●"]
[null,"1110","Top Privacy Officer","Legal/Compliance","Typically created as a response to the HIPAA Privacy Regulation, oversees all ongoing activities related to the development, implementation, maintenance of, and adherence to the organization's policies and procedures covering the privacy of--and access to--patient health information. Ensures compliance with federal and state laws and the health care organization's information privacy practices. Assists in the establishment and serves in a leadership role for an organization-wide Privacy Oversight Committee. Note: This is generally a single incumbent position.","S","●"]
[null,"1120","Chief Information Officer (CIO)","Information Systems","Responsible for the direction, planning, and controls of the information systems (IS) department's activities. Determines and develops strategies for long-term corporate-wide information needs, systems development, and hardware acquisition and integration. Acts to assure integrity of corporate data and proprietary information through information security and access management. Acts as highest interface with non-technical user functions in determining overall information systems approach. Typically reports to the President/Chief Executive Officer (CEO). Note: This is generally a single incumbent position.","S","●"]
[null,"1121","2nd Level Information Systems Executive","Information Systems","Ensures information systems policies and plans created by the Chief Information Officer (CIO) are being implemented effectively. May be responsible for providing direction and oversight to various functions within the department or for a segment of the organization. May determine and develop strategies for long-term information needs, systems development, and hardware acquisition and integration. Typically reports to the Chief Information Officer (CIO) or segment executive management.",null,"●"]
[null,"1122","Chief Information Security Officer","Information Systems","Highest level IT security executive responsible for the organization's development and enforcement of security policy and strategy. Oversees the selection, development, deployment, monitoring, maintenance, and enhancement of the organization's security technology. Performs IT risk assessments, audits, and security incident investigation. Administers security programs and procedures. Frequently reports to a Chief Information Officer. Note: This is generally a single incumbent position.","S","●"]
[null,"1123","Chief Technology Officer (CTO)","Information Systems","Responsible for establishing current and long-range direction of technology aimed at keeping the organization on the forefront of change. Generally, this may include the analysis of purchased systems, hardware and software, or the internal design and development of hardware and software systems. Dispenses technical advice, guidance, direction, and authorization to carry out major plans and procedures. Coordinates the design, development, marketing, and maintenance of technology projects or product lines. Analyzes new technologies and runs competitive analyses. Promotes the interfacing and control of the organization's present technology and the dissemination of technological information throughout the organization. Frequently reports to a Chief Information Officer. Note: This is generally a single incumbent position.","S","●"]
[null,"1124","Top IT Infrastructure Executive","Information Systems","This is the top IT infrastructure position with responsibility for managing the organization's IT architecture that is designed by the CTO/Chief Architect and upon which IT applications operate. Responsible for the physical operation and performance of data centers, servers, networks, and other technology platforms shared across the organization. May oversee other areas such as systems engineering, data center operations, networking/telecommunications, desktop development and support. Frequently reports to a Chief Information Officer. Note: This is generally a single incumbent position. Only one employee, the most senior individual, per organization entity should be reported.","S","●"]
[null,"1125","Top Health Informatics Executive","Information Systems","Responsible for developing and managing the organization's capabilities in information systems and tools that are applied to one or more of the following: medical, actuarial, financial, operational, and various other analytic information in the organization. Coordinates analytical support for organization's claims, utilization, and health care cost data, as well as data from a variety of health care delivery system sources in order to identify areas where cost and utilization need to be reduced. Also responsible for analytics of other areas of the company, including Financial, Actuarial, Operational, etc. This is not an information systems (IS) position. Note: This is generally a single incumbent position.","S","●"]
[null,"1127","Top Business Analytics Executives","Information Systems","Provides leadership, strategic direction, and oversight for business analytics and customer and provider reporting functions which includes stakeholder consulting, database/warehouse management, data mining, predictive modeling, business/market analytics/reporting, and statistical analysis. Responsible for the operational partnership between IT and the business functions with respect to business analytics, database/warehouse management, reporting and analysis applications. Note: This is generally a single incumbent position.","S","●"]
[null,"1129","Top Marketing & Communications Senior Executive","Sales & Marketing","Responsible for planning, directing and coordinating at least two of the following functions: marketing, advertising or communication activities of the organization. Typically reports to the President/Chief Executive Officer (CEO). Please see 1130 Top Marketing Executive or 1155 Top Communications Executive also. Note: This is generally a single incumbent position.","S","●"]
[null,"1130","Top Marketing Executive","Sales & Marketing","Responsible for planning, directing, and coordinating the marketing activities of the organization. Develops and adjusts marketing strategy and plans to meet changing markets and competitive conditions. Responsible for providing advice and guidance to various units regarding markets and marketing. Typically reports to the Top Marketing & Communications Senior Executive or President/Chief Executive Officer (CEO) . Please see 1129 Top Marketing & Communications Senior Executive if the incumbent is responsible for more than just marketing. Note: This is generally a single incumbent position.","S","●"]
[null,"1145","Top Product Development Executive","Sales & Marketing","Responsible for the development of new products, product enhancements, and product redesign for an organization. Develops and implements the organization's product development policies, objectives, and initiatives. Typically reports to Top Marketing Executive. Note: This is generally a single incumbent position.","S","●"]
[null,"1147","Product Line/Segment Product Development Executive","Sales & Marketing","Responsible for the development of new products, product enhancements, and product redesign for a product line or segment. Develops and implements the product development policies, objectives, and initiatives for the product line or segment. Typically reports to Top Product Development Executive.",null,"●"]
[null,"1155","Top Communications Executive","Sales & Marketing","Responsible for all internal and external communication activities. Monitors tone and content of communications to ensure consistency and advancement of organization's philosophy and desirable image. Responsibilities may include press releases, public speaking, newsletters, marketing efforts, and miscellaneous publications. Typically reports to the Top Marketing & Communications Senior Executive or President/Chief Executive Officer (CEO) . Please see 1129 Top Marketing & Communications Senior Executive if the incumbent is responsible for more than just communications. Note: This is generally a single incumbent position.","S","●"]
[null,"1160","Chief Innovation/Transformation Officer","Corporate Support","Responsible for managing the innovation process inside the organization by identifying strategies, business opportunities, and new technologies and for developing these into new capabilities, business models and new products. Inspires ideas from varied sources, selects the ideas to pursue and champions them into products, new businesses, and new processes. Fosters an innovative corporate culture while establishing innovation processes and building idea teams. May also manage a system’s transition from volume to value and leading the organization with the healthcare industry's transformation. Typically reports to the President/Chief Executive Officer (CEO) or Chief Administrative Office (CAO). Note: This is generally a single incumbent position.","B, S","●"]
[null,"1170","Top Strategy, Planning and Development Executive","Corporate Support","Assists the President/Chief Executive Officer (CEO) and other members of top management in establishing short- and long-term organizational objectives and strategic plans. Responsible for identifying organizational strengths and weaknesses. Assesses potential business opportunities. May conduct special studies in areas such as operational effectiveness, capacity utilization, and operating cost containment. May also be responsible for identifying and analyzing possible mergers, acquisitions, and divestitures, and making recommendations as to their impact on the organization's profitability. Typically reports to the President/Chief Executive Officer (CEO) or the Chief Financial Officer (CFO). Note: This is generally a single incumbent position.","B, S","●"]
[null,"1180","Top Government Relations Executive","Corporate Support","Provides policy direction and coordinates efforts of pertinent operating units in matters involving state and federal governments. Maintains effective and cooperative working relationships with federal officials. Typically reports to the Top Legal Executive. Note: This is generally a single incumbent position.","S","●"]
[null,"1185","Top Public Policy Executive","Corporate Support","Responsible for forming and analyzing the organization's policy on health care issues. Focuses on issues of business value to the organization related to the quality, access, and cost of health care, including legislative and regulatory initiatives. Serves as the organization's lead liaison on health care policy issues. Typically reports to the President/Chief Executive Officer (CEO) or Top Legal Counsel. Note: This is generally a single incumbent position.","S","●"]
[null,"1205","Top Quality Assurance Executive","Quality Management","Responsible for directing the overall medical quality programs for an organization. Develops and implements medical quality policies, procedures, and projects. May be responsible for NCQA accreditation. This is not a \"TQM\" or \"CQI\" position. Typically reports to Chief Medical Officer/Medical Director. Note: This is generally a single incumbent position.","S","●"]
[null,"1220","Top Government Programs Executive","Special Services/Product Lines","Responsible for developing marketing strategies, product design, and pricing for benefits and products directed at government programs. Develops and maintains relationships with HCFA and other key stakeholders. Directs development and sale of products. Oversees development and management of provider networks. Directs and manages utilization management, quality assurance, and wellness projects to improve members' health. Typically reports to President/Chief Executive Officer (CEO) or Top Product/Service Line/Specialty Business Unit Executive. Note: This is generally a single incumbent position.","S","●"]
[null,"1230","Top Service Operations Executive","Claims/Member Service","Responsible for the management and coordination of the daily activities and all of the organization's operating units (e.g., claims processing, customer service, etc.). Assists in the development and administration of corporate goals, objectives, plans, and policies. Typically reports to the President/Chief Executive Officer (CEO) or Chief Operating Officer (COO). Note: This is generally a single incumbent position.","S","●"]
[null,"1235","2nd Level Service Operations Executive","Claims/Member Service","Responsible for one or more of the following functions at a regional or segment level: claims processing, member service, membership enrollment and billing, and client administration. Typically reports to Regional/Segment Executive Officer - Health Plans, Top Product/Service Line/Specialty Business Unit Executive, or Top National Accounts Executive.","T","●"]
[null,"1237","Claims Processing Executive","Claims/Member Service","Responsible for the processing of insurance claims to meet operation, financial, and service requirements. Develops and executes strategic and operational business plans for claims processing. Typically reports to Top Service Operations Executive or Chief Operating Officer (COO).","B","●"]
[null,"1238","Member Service Executive","Claims/Member Service","Responsible for developing and implementing policies and procedures for member service, directing and coordinating member service activities, and monitoring quality of the process. Typically reports to Top Service Operations Executive or Chief Operating Officer (COO).","B","●"]
[null,"1239","Membership and Billing Executive","Claims/Member Service","Responsible for membership and billing operations. Develops and implements policies and procedures for enrollment processing, billing and reconciliation, new group implementation/conversions, group maintenance and benefit changes, settlement processing, and income reconciliation. Works with information systems to modify or upgrade technology support of membership and billing operations. Typically reports to Top Service Operations Executive or Chief Operating Officer (COO).","B","●"]
[null,"1240","Top Underwriting Executive","Finance","Responsible for the establishment of premium rates for existing and prospective accounts. Responsible for the establishment and maintenance of accounts in accordance with the organization's goals, thereby impacting its solvency. Typically reports to the Chief Financial Officer (CFO) or Top Actuarial Executive. Note: This is generally a single incumbent position.","S","●"]
[null,"1242","2nd Level Underwriting Executive","Finance","Ensures pricing and underwriting practices and policies created by the Top Underwriting Executive are being implemented effectively. May be responsible for providing direction and oversight to various functions within the department or for a segment of the organization. Typically reports to Top Underwriting Executive or segment executive management.",null,"●"]
[null,"1245","General Manager / Market Leader","Senior Governing Executives","Responsible for the development, operations, and results of a health plan. Establishes long-range goals, objectives, and plans; monitors financial and operational performance; and coordinates activities of senior managers and their respective functions. Represents the health plan externally and to governmental/external agencies. Typically reports to the Regional Executive Officer - Health Plans or to Segment Head.",null,"●"]
[null,"1250","Top Provider Network Executive","Provider Network","Responsible for the entire provider network function including network development, contracting, credentialing, provider relations, and provider services. Coordinates project management across departments. Ensures a comprehensive, cost-effective, and accessible provider network. Typically reports to President/Chief Executive Officer (CEO) or Chief Operating Officer (COO). Note: This is generally a single incumbent position.","S","●"]
[null,"1255","Provider Network Executive","Provider Network","Responsible for the development and management of a provider network for a region or segment, which may include network development, contracting, credentialing, provider relations, and provider services. May also be responsible for providing policy administration for provider networks and ensuring contractual compliance with government regulations. Typically reports to Regional/Segment Executive Officer - Health Plans or Top Provider Network Executive.","T","●"]
[null,"1260","Top Sales and Marketing Executive","Sales & Marketing","Responsible for development, implementation, and administration of sales and marketing programs. Develops new markets, recommends improvements in products and services, directs and manages sales and marketing functions and staff, and develops sales strategies to meet operating and financial goals. Typically reports to President/Chief Executive Officer (CEO) or Chief Operating Officer (COO). Note: This is generally a single incumbent position.","S","●"]
[null,"1263","Sales/Marketing Executive","Sales & Marketing","Responsible for development, implementation, and administration of the sales and/or marketing programs for a region or segment. Develops sales strategies to meet operating and financial goals. Directs and manages sales and/or marketing functions and staff. Typically reports to Regional/Segment Executive Officer - Health Plans, Top Sales Executive, or Top Marketing Executive.","T","●"]
[null,"1264","Product Line/Specialty Business Sales Executive","Sales & Marketing","Responsible for development, implementation, and administration of sales programs for a product line or a specialty business. Develops new markets, recommends improvements in products and services, directs and manages sales and marketing functions and staff, and develops sales strategies to meet operating and financial goals for a product/service line/specialty business unit. Typically reports to Top Sales and Marketing Executive or Chief Operating Officer (COO).","T","●"]
[null,"1265","Top Sales Executive","Sales & Marketing","Responsible for developing and implementing sales strategies for the entire sales function. Oversees the activities of the field sales force and develops overall membership and revenue growth targets for dissemination throughout the sales function. Typically has ten or more years of experience in group health sales. Typically reports to Top Product/Service Line/Specialty Business Unit Executive, Top Sales and Marketing Executive, or Top Marketing Executive. Note: This is generally a single incumbent position.","S","●"]
[null,"1266","Top National Accounts Executive","Sales & Marketing","Responsible for directing and coordinating all national accounts. Develops and implements sales strategies to achieve revenue targets and service goals for the largest and most complex accounts in the organization. Typically reports to President/Chief Executive Officer (CEO) or Top Sales and Marketing Executive. Note: This is generally a single incumbent position.","S","●"]
[null,"1267","Top Consumer Business Executive","Sales & Marketing","Responsible for the individual product sales group. Responsible for current and emerging distribution channels to maximize sales of the individual products (retail, broker and direct to consumer channels). Focuses externally on developing both the broker channel, and developing internal and external strategic partnerships. Delivers on execution of the business strategy. Develops relationships and understanding of the consumer market. Note: This is generally a single incumbent position.","S","●"]
[null,"1268","Top Consumer Experience Executive","Sales & Marketing","Responsible for creating and monitoring the consumer experience in a health plan. Note: This is generally a single incumbent position. Only one employee, the most senior individual, per organization entity should be reported.","S","●"]
[null,"1270","Top Actuarial Executive","Finance","Responsible for developing the organization's premium rate structure through regular and systematic analysis and forecasting of financial/statistical data which is actuarially sound, competitive in the marketplace, and provides income in accordance with organizational goals and objectives. Directs the preparation of rate and formula filing to the State Insurance Department and participates in public hearings concerning such matters as required. Typically reports to Chief Financial Officer (CFO). Note: This is generally a single incumbent position.","S","●"]
[null,"1275","2nd Level Actuarial Executive","Finance","Ensures actuarial practices and policies created by the Top Actuarial Executive are being implemented effectively. Ensures the development of the premium rate structure through regular and systematic analysis and forecasting of financial/statistical data. May be responsible for providing direction and oversight to various functions within the department or for a segment of the organization. Typically reports to Top Actuarial Executive or segment executive management.",null,"●"]
[null,"1285","Top Dental Executive","Special Services/Product Lines","Responsible for the operations, growth, and financial performance of the dental segment of the organization. May also be responsible for the sales and marketing, claims, and product development for the dental segment. Typically reports to Product/Service Line/Specialty Business Unit Executive or Chief Operating Officer (COO). Note: This is generally a single incumbent position.","S","●"]
[null,"1290","Top Provider Network Contracting Executive","Provider Network","Responsible for the overall contracting of a provider network for the organization. Ensures that the organization's policies for drafting contracts, conducting negotiations, and administering provider agreements are followed. May also be responsible for contractual compliance with government regulations. Typically reports to Top Provider Networks Executive, Chief Finance Officer (CFO), or Chief Operating Executive (COO). Note: This is generally a single incumbent position.","S","●"]
[null,"1292","Provider Contracting Executive","Provider Network","Responsible for the contracting of a provider network for a region or segment. Ensures that the organization's policies for drafting contracts, conducting negotiations, and administering provider agreements are followed. May also be responsible for contractual compliance with government regulations. Typically reports to Top Provider Networks Executive, Top Provider Network Contracting Executive or Regional/Segment Executive Officer - Health Plans.","T","●"]
[null,"1305","Top Behavioral Health Executive","Special Services/Product Lines","Responsible for the operating results and growth of the behavioral care services organization. Develops strategic plans, goals, and objectives. Ensures implementation of utilization management systems and programs, increases membership through effective management of the sales and marketing workforce, and ensures operational effectiveness and quality. Manages relationships with behavioral care providers. Top Product/Service Line/Specialty Business Unit Executive. Note: This is generally a single incumbent position.","S","●"]
[null,"1320","Chief Medical Officer","Medical Executives","Responsible for strategic medical affairs issues including developing physician networks, joint ventures, and physician relationships; recruiting physicians and physician groups; establishing fee for service management services; and establishing and implementing standards and policies to ensure the quality of the medical care provided to patients. Provides advice and counsel to corporate administrators on medical and administrative matters. Typically reports to the President/Chief Executive Officer (CEO) or Chief Operating Officer (COO). Note: This is generally a single incumbent position.","S","●"]
[null,"1321","Regional/Segment Medical Director","Medical Executives","Directs the medical policy for a region or segment. Establishes and implements policies and standards, evaluates new treatments, and conducts medical research to ensure the quality of the medical care provided to patients for a region or segment. Directs the activities of appropriate staff. Typically reports to Chief Medical Officer or Regional/Segment Executive Officer - Health Plans.",null,"●"]
[null,"1332","Clinical Operations/Services Executive","Medical Executives","Responsible for the development and implementation of the clinical operations/services for the organization; ensures local approaches are coordinated with and complimentary to health care management programs and provider contracting strategies, and manages external vendors and external vendor strategy. May require an MD. Frequently reports to the Chief Medical Officer. Note: This is generally a single incumbent position.","B, S","●"]
[null,"1335","Top Pharmacy Executive","Special Services/Product Lines","Responsible for developing and maintaining strategies to manage pharmaceuticals that produce the best outcomes at the lowest cost. Develops strategies for managing and measuring appropriate pharmacy utilization, negotiates and monitors contracts with outside vendors, contributes to building physician incentive programs aimed at increasing pharmaceutical usage, and stays abreast of pharmacy and payer industry changes. May have a Doctor of Pharmacy degree. Typically reports to the Chief Medical Officer/Medical Director. Note: This is generally a single incumbent position. If your incumbent is over the Pharmacy Benefit Management Group also (PBM), please see position 1338 Top Pharmacy Benefit Management Executive.","S","●"]
[null,"1338","Top Pharmacy Benefits Management (PBM) Executive","Special Services/Product Lines","Responsible for developing and managing the pharmacy benefit management (PBM) business unit within the organization. Develops and implements marketing plans, budgets, objectives, and policies and procedures for pharmacy benefit management business. Directs the activities of appropriate staff. May also be responsible for the operations of mail-order pharmacy centers. Typically reports to the Top Product/Service Line/Specialty Business Unit Executive or the President/Chief Executive Officer (CEO). Note: This is generally a single incumbent position.","S","●"]
[null,"1340","Top Medicare Executive","Special Services/Product Lines","Responsible for developing and implementing the vision for serving the Medicare market. Accountable for product performance, compliance, and operations through the direct oversight of product development and management, medical management, sales and marketing, member services, operations, claims processing and provider service. Ensures administrative spending and financial risks are managed against regulatory compliance and contractual obligations. Typically reports to Product/Service Line/Specialty Business Unit Executive or Chief Operating Officer (COO). Note: This is generally a single incumbent position.","S","●"]
[null,"1342","Top Medicaid Executive","Special Services/Product Lines","Responsible for developing and implementing the vision for serving the Medicaid market. Accountable for product performance, compliance, and operations through the direct oversight of product development and management, medical management, sales and marketing, member services, operations, claims processing and provider service. Ensures administrative spending and financial risks are managed against regulatory compliance and contractual obligations. Typically reports to Top Segment /Specialty Business Executive or Top Government Programs Executive. Note: This is generally a single incumbent position.","S","●"]
[null,"1345","Top STARS Program Executive","Special Services/Product Lines","Responsible for the strategy, development, and overall oversight of the company's Medicare Stars Program. Drives all Stars quality improvement programs and initiatives. Note: This is generally a single incumbent position.","S","●"]
[null,"1360","Top Product Line Executive","Senior Governing Executives","Responsible for developing and managing a product line within the organization. Develops and implements marketing plans, budgets, objectives, and policies and procedures for the product line. Directs the activities of appropriate staff. Typically reports to Top Segment /Specialty Business Executive. If incumbent is responsible for Dental, please see 1285 Top Dental Executive; for Medicare, please see 1340 Top Medicare Executive; for any other government program, please see 1220 Top Government Programs Executive; for Pharmacy, please see 1335 Top Pharmacy Executive; for PBM, please see 1338 Top PBM Executive; and for Behavioral Health, please see 1305 Top Behavioral Health Executive.",null,"●"]
[null,"1365","Top Segment /Specialty Business Executive","Senior Governing Executives","Responsible for a segment which may include the specialty business segment including directing several product/service lines/specialty business units within the organization. Develops and implements marketing plans, budgets, objectives, and policies and procedures for the product/service lines. Directs the activities of appropriate staff. Typically reports to President/Chief Executive Officer (CEO) or Chief Operating Officer (COO). If incumbent is responsible for Dental, please see 1285 Top Dental Executive; for Medicare, please see 1340 Top Medicare Executive; for any other government program, please see 1220 Top Government Programs Executive; for Pharmacy, please see 1335 Top Pharmacy Executive; for PBM, please see 1338 Top PBM Executive; and for Behavioral Health, please see 1305 Top Behavioral Health Executive.",null,"●"]
[null,"1400","Top Digital Marketing Executive","Sales & Marketing","Responsible for the digital marketing of the organization which may include the organization's website, social media presence, and digital campaigns. Provides strategic and tactical leadership to build, manage, and protect the company's digital footprint. Typically reports to the Top Marketing Executive or the Top Communications Executive. Note: This is generally a single incumbent position.","S","●"]
[null,"1500","Top Philanthropy Executive","Corporate Support","Responsible for developing and implementing a strategic approach to the company's philanthropic activities and managing company foundations and corporate contributions budget. Provides strategic and tactical leadership to build, manage, and protect the company's reputation. Typically requires BS/BA in community and public relations or related field. Typically reports to President/Chief Executive Officer (CEO) or Top Marketing Executive. Note: This is generally a single incumbent position.","S","●"]
[null,"1600","Top Human Resources Executive","Human Resources","Responsible for the overall strategic planning and administration of the human resources function across the organization. Develops and maintains a human resources information system, formulates human resources policies, recruits executive level personnel, and monitors overall compliance with government regulations. Creates objectives for organization-wide plans such as compensation and benefits, organizational development, training, labor relations and diversity. Typically reports to the President/Chief Executive Officer (CEO), Chief Operating Officer (COO), or Top Administrative Services Executive. Note: This is generally a single incumbent position.","S","●"]
[null,"1603","2nd Level Human Resources Executive","Human Resources","Ensures the strategic planning and administration of the human resources and practices and policies created by the Top Human Resources Executive are being implemented effectively. May be responsible for providing direction and oversight to various functions such as compensation, organizational development, recruiting, training, labor relations and diversity within the department or for a segment of the organization. Typically reports to Top Human Resources Executive or segment executive management.",null,"●"]
[null,"1610","Top Talent Management Executive","Human Resources","Responsible for the strategic direction of programs to meet the training, development, and talent management needs of the organization. May also be titled organization development or chief learning officer. Typically reports to Top Human Resources Executive. Note: This is generally a single incumbent position.","B, S","●"]
[null,"1615","Top Total Rewards Executive","Human Resources","Responsible for the design, implementation, and administration of all compensation and benefits programs for all employees. Typically reports to the Top Human Resources Executive. Note: This is generally a single incumbent position.","B, S","●"]
[null,"1620","Compensation Executive","Human Resources","Directs the planning, administration, and implementation of job evaluation, performance appraisal, and wage and salary management programs for the organization. Plans and administers all incentive programs within the guidelines of established policies. Manages the conduct or participation in wage and salary surveys and recommends changes to ensure the maintenance of the organization's compensation objectives and competitive position in the marketplace. May have overall responsibility for implementing stock option plans and other executive compensation long-term incentive plans. Typically reports to a Top Human Resources Executive.","B","●"]
[null,"1625","Benefits Executive","Human Resources","Responsible for the planning and administration of the various employee benefit programs, including, but not limited to, life, health, and disability insurance, as well as pension, profit-sharing, and related retirement programs. Recommends new and/or improved employee benefit plans and cost-saving measures. Ensures compliance with all legal requirements of various employee benefit programs and prepares and files required legal reports. Typically reports to a Top Human Resources Executive.","B","●"]
[null,"1630","Top Diversity & Inclusion Executive","Human Resources","Responsible for the leading strategies and practices designed to attract and retain a diverse, inclusive, and highly qualified workforce. Collaborates to set policy and is responsible for developing and facilitating comprehensive short-, mid-, and long-term strategies for implementing cultural change in all aspects of how the company leverages recruiting, diversity and inclusion. Ensures a legally compliant and administratively efficient process. May serve on an Inclusion Council. Typically reports to a Top Human Resources Executive. Note: This is generally a single incumbent position.","S","●"]
[null,"1800","Top Internal Audit Executive","Finance","Responsible for planning, developing, recommending, and monitoring procedures and systems to be used in internal auditing throughout the organization. Also, responsible for the supervision of the audit staff. May be responsible for managing audits of joint ventures, partnerships, and subsidiaries. Typically reports functionally to the Board of Directors and administratively to the Chief Financial Officer (CFO) or the President/Chief Executive Officer (CEO). Note: This is generally a single incumbent position.","S","●"]
[null,"1805","2nd Level Internal Audit Executive","Finance","Responsible for planning, developing, recommending, and monitoring procedures and systems to be used in internal auditing throughout the organization. Ensures system accuracy and consistency. May assist with managing audits of joint ventures, partnerships, and subsidiaries. Typically in larger organizations this is a senior level manager/director position. Typically reports to the Top Internal Audit Executive.",null,"●"]
[null,"1900","Top Project Management Office (PMO) Executive","Corporate Support","This is the top Program/Project Management Executive, responsible for building and leading the program/project management office or function (PMO). Defines and develops program/project management best practices, processes, and policy to ensure alignment with corporate strategy and goals. Partners with multi-departmental leadership and other stakeholders to locate opportunities and develop and prioritize programs/projects according to relevant measurement criteria. Responsible for the supervision of program/project managers to ensure that all projects are delivered within the defined scope, quality, time and cost requirements. Note: This is generally a single incumbent position.","S","●"]
[null,"2000","Director, Claims Processing","Claims Processing","Directs the processing of insurance claims to meet operation, financial, and service requirements. Develops and executes strategic and operational business plans for the department. Coordinates department operations and modifications with other areas of the organization. Typically holds a Bachelor's degree in business administration and has seven or more years of experience in claims processing with three to five years of management experience. Normally reports to the Claims Processing Executive."]
[null,"2005","Manager, Claims Processing","Claims Processing","Responsible for the operations of one or more claims processing units, including timely and proper adjudication of claims in accordance with contractual benefits. Also, provides training, direction, and support of predominately nonexempt staff. Responsible for hiring, training, and firing staff. Typically holds a Bachelor's degree in business administration and has six or more years of experience in claims processing with two to three years of supervisory experience. Normally reports to the Director, Claims Processing."]
[null,"2007","Supervisor, Claims Processing","Claims Processing","Supervises the accurate and timely adjudication of claims and administers disposition according to contractual benefits and company procedures. Provides technical support to claims processors. Typically is a high school graduate and has five or more years of experience in claims processing. Normally reports to the Director or Manager, Claims Processing."]
[null,"2009","Claims Processor - Lead","Claims Processing","Responsible for instructing, directing, and checking the work of other claims processors. Determines whether to return, deny, or pay claims following organizational policies and procedures. May provide guidance or expertise to less experienced claims processors. Handles escalated and unresolved claims from less experienced claims processors. Typically has five or more years of experience in processing and adjudicating claims."]
[null,"2011","Claims Processor - Senior","Claims Processing","Under general direction, reviews and adjudicates complex/specialty paper/electronic claims. Determines whether to return, deny, or pay claims following organizational policies and procedures. May provide guidance or expertise to less experienced claims processors. Typically has five or more years of experience in processing and adjudicating claims."]
[null,"2012","Claims Processor - Intermediate","Claims Processing","Under general supervision, reviews and adjudicates complex/specialty paper/electronic claims. Determines whether to return, deny, or pay claims following organizational policies and procedures. Typically has three to five years of experience in processing and adjudicating claims."]
[null,"2013","Claims Processor - Associate","Claims Processing","Under direct supervision, reviews and adjudicates paper/electronic claims. Determines whether to return, deny, or pay claims following organizational policies and procedures. Typically has less than three years of experience in processing and adjudicating claims."]
[null,"2015","Director, Member Service","Member Services","Responsible for the department that responds to member inquiries. Develops and implements policies and procedures. Responsible for compliance with member service procedures. Typically holds a Bachelor's degree and has seven or more years of experience with three to five years of management experience. Normally reports to the Member Service Executive."]
[null,"2020","Manager, Member Service","Member Services","Responsible for the daily operations of the department which responds to inquiries by the members of the health plan. Directs staff on proper member service procedures and monitors service levels. Analyzes causes of member inquiries. Responsible for hiring, training, and firing of staff. Typically holds a Bachelor's degree and has six or more years of experience with two to three years of supervisory experience. Normally reports to the Director, Member Service."]
[null,"2023","Supervisor, Member Service","Member Services","Supervises a unit which responds to member inquiries. Conducts research to determine inquiry causes and reports problem areas to appropriate management. Provides expertise and guidance to member service representatives. Typically has five or more years of experience. Normally reports to the Director or Manager, Member Service."]
[null,"2024","Member Service Representative - Lead","Member Services","Responsible for instructing, directing, and checking the work of other representatives. Provides customer service to plan members by answering complex benefit questions, resolving issues, and educating members. Handles escalated and unresolved calls from less experienced representatives. Typically has five or more years of customer service experience."]
[null,"2025","Member Service Representative - Specialist","Member Services","Under general direction, provides specialized personal customer service to plan members by answering complex benefit questions, resolving issues, and educating members. Receives telephone, internet, and written inquiries from members regarding covered benefits. May provide guidance or expertise to less experienced representatives and takes on the more high profile members and claims. Recognized as an expert in dealing with members and difficult or complex situations. Typically has five or more years of customer service experience."]
[null,"2026","Member Service Representative - Senior","Member Services","Under general direction, provides customer service to plan members by answering complex benefit questions, resolving issues, and educating members. Receives telephone, internet, and written inquiries from members regarding covered benefits. May provide guidance or expertise to less experienced representatives. Typically has five or more years of customer service experience."]
[null,"2027","Member Service Representative - Intermediate","Member Services","Under general supervision, provides customer service to plan members by answering complex benefit questions, resolving issues, and educating members. Receives telephone, internet, and written inquiries from members regarding covered benefits. Typically has three to five years of customer service experience."]
[null,"2028","Member Service Representative - Associate","Member Services","Under direct supervision, provides customer service to plan members by answering complex benefit questions, resolving issues, and educating members. Receives telephone, internet, and written inquiries from members regarding covered benefits. Typically has less than three years of customer service experience.","D"]
[null,"2029","Customer Service Traffic Representative","Member Services","Forecasts incoming call volume and resources needed based on metrics and trends. Ensures proper staffing levels to meet contractual obligations and established metrics. Collaborates with the appropriate departments to identify issues that impact staffing levels. Typically requires two or more years of experience in workforce management."]
[null,"2030","Director, Membership Enrollment and Billing","Membership Enrollment & Billing","Responsible for the operations and processes for member enrollment and billing. Develops and monitors enrollment and billing policies and procedures. Ensures process efficiency and service quality. May take a leadership role in addressing broad, complex enrollment and billing issues. Typically holds a Bachelor's degree and has seven or more years of experience in membership enrollment and billing with three to five of management experience."]
[null,"2035","Manager, Membership Enrollment and Billing","Membership Enrollment & Billing","Responsible for the preparing, processing, and maintenance of enrollment and billing information for new and current members. May be responsible for or assist in addressing broad, complex enrollment and billing issues. Responsible for hiring, training, and firing staff. Typically holds a Bachelor's degree and has six or more years of experience in membership enrollment and billing with two to three years of supervisory experience. Normally reports to the Director, Membership Enrollment and Billing."]
[null,"2040","Supervisor, Membership Enrollment and Billing","Membership Enrollment & Billing","Supervises the preparing, processing, and maintenance of enrollment and billing information for new and current members. Provides technical support to enrollment and billing staff. Typically is a high school graduate and has five or more years of experience in enrollment and billing. Normally reports to the Director or Manager, Membership Enrollment and Billing."]
[null,"2041","Enrollment Representative - Senior","Membership Enrollment & Billing","Under general direction, responds to incoming calls and may initiate outgoing calls. Verifies enrollment status, makes changes to records, addresses a variety of enrollment questions or concerns, and maintains enrollment databases. May provide guidance or expertise to less experienced representatives. Typically requires five or more years of enrollment experience."]
[null,"2042","Enrollment Representative - Intermediate","Membership Enrollment & Billing","Under general supervision, responds to incoming calls and may initiate outgoing calls. Verifies enrollment status, makes changes to records, addresses a variety of enrollment questions or concerns, and maintains enrollment databases. Typically requires three to five years of enrollment experience."]
[null,"2043","Enrollment Representative - Associate","Membership Enrollment & Billing","Under direct supervision, responds to incoming calls and may initiate outgoing calls. Verifies enrollment status, makes changes to records, addresses a variety of enrollment questions or concerns, and maintains enrollment databases. Typically has less than three years of enrollment experience."]
[null,"2044","Enrollment and Billing Representative - Senior","Membership Enrollment & Billing","Under general direction, responsible for enrollment and billing activities for the membership, enrollment & billing department. Typically requires five or more years of enrollment and/or billing experience."]
[null,"2045","Enrollment and Billing Representative - Intermediate","Membership Enrollment & Billing","Under general supervision, responsible for enrollment and billing activities for the membership, enrollment & billing department. Typically requires three to five years of enrollment and/or billing experience."]
[null,"2046","Enrollment and Billing Representative - Associate","Membership Enrollment & Billing","Under direct supervision, responsible for enrollment and billing activities for the membership, enrollment & billing department. Typically has less than three years of enrollment and/or billing experience."]
[null,"2047","Premium Billing Analyst - Senior","Membership Enrollment & Billing","Under general direction, responsible for complex group insurance customer billing, accounts receivable, and commission payments; provides service to customers regarding types of payments; reconciles complex accounts; handles collections, lapses, and reinstatements; and provides service to brokers and sales personnel regarding commissions. Analyzes and reports financial information to policyholders, agents, brokers, underwriters, and customers. May provide guidance or expertise to less experienced representatives. Typically requires five or more years of customer billing and accounts receivable experience."]
[null,"2048","Premium Billing Analyst - Intermediate","Membership Enrollment & Billing","Under general supervision, responsible for complex group insurance customer billing, accounts receivable, and commission payments; provides service to customers regarding types of payments; reconciles complex accounts; handles collections, lapses, and reinstatements; and provides service to brokers and sales personnel regarding commissions. Analyzes and reports financial information to policyholders, agents, brokers, underwriters, and customers. Typically requires three to five years of customer billing and accounts receivable experience."]
[null,"2049","Premium Billing Analyst - Associate","Membership Enrollment & Billing","Under direct supervision, responsible for group insurance customer billing, accounts receivable, and commission payments; provides service to customers regarding types of payments; reconciles accounts; handles collections, lapses, and reinstatements; and provides service to brokers and sales personnel regarding commissions. Typically has less than three years of customer billing and accounts receivable experience."]
[null,"2050","Senior Director, Service Operations","Service Operations","Responsible for leading several operating functions in a business unit. Functional areas may include but not limited to: installation, implementation, client support, client services, client administration, customer service, enrollment and eligibility, claims processing, and call center operations. Typically requires eight or more years of experience, including four or more years of management experience and reports to the business unit Chief Executive Officer (CEO) or Chief Operations Officer (COO). NOTE: This is a second level management role consisting of multiple incumbents, which may not exist in some organizations/locations."]
[null,"2051","Director, Service Operations","Service Operations","Directs the multi-functional area handling service issues. Functional areas may include but not limited to: installation, implementation, client support, client services, client administration, customer service, enrollment and eligibility, claims processing, and call center operations. Coordinates department operations and modifications with other areas of the organization. Typically holds a Bachelor's degree in business administration and has seven or more years of experience in a client service area with three or more years of management experience."]
[null,"2053","Manager, Service Operations","Service Operations","Manages the daily activities of the multi-functional area handling service issues. Functional areas may include but not limited to: installation, implementation, client support, client services, client administration, customer service, enrollment and eligibility, claims processing, and call center operations. Investigates and settles claims and customer service issues not resolvable by lower staff members. Typically holds a Bachelor's degree and has six or more years of experience in a client service area with two to three years of supervisory experience."]
[null,"2055","Supervisor, Service Operations","Service Operations","Supervises and provides daily direction to multi-functional team members regarding training and development, policies, procedures, and work production quantity and quality. Reviews and resolves complex service issues not resolvable by subordinates. Typically holds a Bachelor's degree and has five or more years of experience in a client service area."]
[null,"2056","Service Representative - Senior","Service Operations","Under general direction, acts as end-to-end contact for clients experiencing service problems. Reviews and adjudicates complex claims and/or adjustments and responds to and resolves complex inquiries and concerns from policy holders, providers, and/or others. Interacts with providers and claimants to correct claim form errors or omissions and to investigate questionable entries. Typically has three or more years of experience in claims and customer service."]
[null,"2057","Service Representative - Associate","Service Operations","Under direct supervision, acts as end-to-end contact for clients experiencing service problems. Reviews and adjudicates claims and/or adjustments and responds to and resolves complex inquiries and concerns from policy holders, providers, and/or others. Interacts with providers and claimants to correct claim form errors or omissions and to investigate questionable entries. Typically has less than three years of experience in claims and customer service.","D"]
[null,"2059","Intake/Referral Representative","Service Operations","Responsible for providing support to a clinical team in order to facilitate the administrative components of clinical referrals for various services. Acts as a liaison between hospitals, physicians, health plans, vendors, and patients or referral sources. Primary duties may include, but are not limited to initiating and managing clinical referrals for registered participants. Verifies insurance coverage and obtains authorizations if needed from insurance plans. Enters referrals and documents communications, actions, and other data in system. Typically requires a high school diploma with one to three years of experience in the health care environment."]
[null,"2060","Director, Claims - Quality Audit","Claims Quality Assurance/Audit","Responsible for the quality claims audit function in the claims processing area. Develops claims audit policies and procedures. May recommend changes in claims processing procedures. May be directly involved in complex claims audits. Provides expertise and guidance on technical or procedural issues. Typically has seven or more years of experience in claims processing with three to five years of management experience."]
[null,"2065","Manager, Claims - Quality Audit","Claims Quality Assurance/Audit","Responsible for the daily operations of the quality claims audit function in the claims processing area. Assists in the development of claims audit policies and procedures. May recommend changes in claims processing procedures. May be directly involved in complex claims audits. Responsible for hiring, training, and firing staff. Typically has five or more years of experience with two to three years of supervisory experience."]
[null,"2067","Supervisor, Claims - Quality Audit","Claims Quality Assurance/Audit","Supervises the activities of the quality claims audit function in the claims processing area. Assists in the development of claims audit policies and procedures. May recommend changes in claims processing procedures and may be directly involved in complex claims audits. Typically has five or more years of experience in this area."]
[null,"2070","Claims Quality Auditor - Senior","Claims Quality Assurance/Audit","Under general direction, audits claims for coding accuracy, benefit payment, contract interpretation, and compliance with policies and procedures. Selects claims through random processes and/or other criteria. Responds to audit rebuttals. May provide guidance or expertise to less experienced quality auditors. Typically has five or more years of claims auditing experience and three or more years of experience in claims adjudication."]
[null,"2071","Claims Quality Auditor - Intermediate","Claims Quality Assurance/Audit","Under general supervision, audits claims for coding accuracy, benefit payment, contract interpretation, and compliance with policies and procedures. Selects claims through random processes and/or other criteria. Typically has three to five years of claims auditing experience and three or more years of experience in claims adjudication."]
[null,"2072","Claims Quality Auditor - Associate","Claims Quality Assurance/Audit","Under direct supervision, audits claims for coding accuracy, benefit payment, contract interpretation, and compliance with policies and procedures. Selects claims through random processes and/or other criteria. Typically has less than three years of claims auditing experience and three or more years of experience in claims adjudication."]
[null,"2080","Customer Service Quality Assurance Audit - Senior","Claims Quality Assurance/Audit","Under general direction, monitors and evaluates the quality of inbound and/or outbound customer service calls. Documents quality issues and performance measures for management review. Provides information to assist in the feedback and formal education process of individuals on the phone. May assist in the development of monitoring standards. May act as subject matter expert. Typically has three or more years of related experience."]
[null,"2081","Customer Service Quality Assurance Audit - Associate","Claims Quality Assurance/Audit","Under direct supervision, monitors and evaluates the quality of inbound and/or outbound customer service calls. Documents quality issues and performance measures for management review. Provides information to assist in the feedback and formal education process of individuals on the phone. May act as subject matter expert. Typically has less than three years of related experience.","D"]
[null,"2087","Manager, Subrogation/Other Party Liability (OPL)","Subrogation/OPL","Responsible for the daily operations of the department which processes duplicate coverage, workers' compensation, and no-fault claims according to established standards and schedules. Develops and maintains efficient other party liability (OPL) and coordination of benefits (COB) systems. May be responsible for hiring, training, and firing staff. Typically holds a Bachelor's degree and has six or more years of related experience with two to three years of supervisory experience. Normally reports to the Director, Subrogation/Other Party Liability (OPL)."]
[null,"2090","Supervisor, Subrogation/Other Party Liability (OPL)","Subrogation/OPL","Supervises the activities of the department which processes duplicate coverage, workers' compensation, and no-fault claims according to established standards and schedules. Develops and maintains efficient other party liability (OPL) and coordination of benefits (COB) systems. May be responsible for hiring, training, and firing staff. Typically holds a Bachelor's degree and five or more years of related experience."]
[null,"2095","Subrogation/Other Party Liability (OPL) Specialist - Senior","Subrogation/OPL","Under general direction, processes subrogation, workers' compensation, and other claims where third party liability may exist. Develops cases resulting from beneficiary and provider-initiated inquiries, internal referrals, personal research, and/or computer-generated reports. Typically has three or more years of experience in claims and/or subrogation."]
[null,"2096","Subrogation/Other Party Liability (OPL) Specialist - Associate","Subrogation/OPL","Under direct supervision, assists in the recovery of overpayments by researching paid claims; answering inquiries; and interacting with other departments, insurance adjustors, attorneys, and members. Typically has less than three years of related experience.","D"]
[null,"2097","Coordination of Benefits Representative","Subrogation/OPL","Initiates contact to membership, providers, other insurance companies to gather coordination of benefits (COB) data. Consolidates the activities that support the collection, management, and reporting of other insurance coverage."]
[null,"2100","Director, Health Services","Health Services","Directs the case management, medical review, utilization review, quality management, and/or health education programs. Provides strategic planning, decision making, and direction of a quality, cost effective delivery system providing health services to members. Manages inpatient and outpatient medical costs at levels consistent with the plan's objectives. Typically has seven or more years of related experience in health care with three to five years of management experience."]
[null,"2105","Manager, Health Services","Health Services","Plans, organizes, and manages the case management, medical review, utilization review, quality management, and/or health education programs. Analyzes inpatient and outpatient utilization trends. Develops and implements action plans to improve utilization and quality. Typically has six or more years of related experience in health care with two to three years of supervisory experience."]
[null,"2110","Director, Clinical Programs","Clinical Programs","Oversees and directs the development, evaluation and implementation of new or changing health care programs and medical services for the organization at the national level. Responsible for program execution and drives medical program management for specific clinical programs. Negotiates with vendor to provide programs and product development. Typically has a clinical background as a RN."]
[null,"2115","Director, Case Management","Case Management","Directs the planning and delivery of case management services. Develops and implements policies and procedures to enhance cost effectiveness while providing quality care. Typically has seven or more years of experience in case management with three to five years of management experience."]
[null,"2120","Manager, Case Management","Case Management","Manages and coordinates the delivery of case management services, including the coordination of disciplines/service areas, periodic reporting, and communications. Facilitates collaboration between utilization management and case management. May make recommendations for specific case exceptions. Responsible for hiring, training, and firing staff. Typically has six or more years of experience in case management with two to three years of supervisory experience."]
[null,"2125","Telephonic Case Manager - Senior","Case Management","Under general direction, responsible for care coordination and health education for plan members through telephonic collaboration with members, their family, and providers. Identifies members' medical, behavioral, and social needs and barriers to care and develops a comprehensive care plan that closes gaps in preventive care, addresses barriers to care, and supports the member's self-management of chronic illness. Collaborates and facilitates care with providers, community resources, and caregivers to provide additional support. Requires RN with typically five or more years of clinical and case management experience."]
[null,"2128","Telephonic Case Manager - Intermediate","Case Management","Under general supervision, responsible for care coordination and health education for plan members through telephonic collaboration with members, their family, and providers. Identifies members' medical, behavioral, and social needs and barriers to care and develops a comprehensive care plan that closes gaps in preventive care, addresses barriers to care, and supports the member's self-management of chronic illness. Collaborates and facilitates care with providers, community resources, and caregivers to provide additional support. Requires RN with typically three to five years of clinical and case management experience."]
[null,"2130","Telephonic Case Manager - Associate","Case Management","Under direct supervision, responsible for care coordination and health education for plan members through telephonic collaboration with members, their family, and providers. Identifies members' medical, behavioral, and social needs and barriers to care and develops a comprehensive care plan that closes gaps in preventive care, addresses barriers to care, and supports the member's self-management of chronic illness. Collaborates and facilitates care with providers, community resources, and caregivers to provide additional support. Requires RN with typically less than three years of clinical and case management experience."]
[null,"2131","Field Case Manager - Senior","Case Management","Under general direction, provides support to patients, their families, and physicians in addressing medical and social concerns on-site at provider facilities and member homes. Educates patients and families to make informed personal health care decisions. Facilitates communication between patient, physician, health plan, and community. Requires RN with typically five or more years of clinical and case management experience."]
[null,"2132","Field Case Manager - Intermediate","Case Management","Under general supervision, provides support to patients, their families, and physicians in addressing medical and social concerns on-site at provider facilities and member homes. Educates patients and families to make informed personal health care decisions. Facilitates communication between patient, physician, health plan, and community. Requires RN with typically three to five years of clinical and case management experience."]
[null,"2133","Field Case Manager - Associate","Case Management","Under direct supervision, provides support to patients, their families, and physicians in addressing medical and social concerns on-site at provider facilities and member homes. Educates patients and families to make informed personal health care decisions. Facilitates communication between patient, physician, health plan, and community. Requires RN with typically less than three years of clinical and case management experience."]
[null,"2135","Disease Case Management Consultant","Case Management","Provides case management and education to participants enrolled in a disease management program (e.g., Diabetes). Identifies major health risk factors, reinforces physician's plan of treatment, and assists with benefits management as needed. Acts as a liaison between the participant, employer, and physician for work adaptation needs. Stays abreast of health care changes and documents program's progress. Typically requires a RN."]
[null,"2140","Internal Wellness Manager","Internal Wellness Program","Administers the internal wellness program's daily operations area including project management, planning, communications, and vendor relations. Tracks, monitors, and reports program results. Leads internal wellness related projects and events."]
[null,"2143","Internal Health & Wellness Consultant","Internal Wellness Program","Provides consultation to internal stakeholders concerning health initiatives and wellness goals. Coordinates internal worksite wellness education programs to improve employees health status and to support the company's culture, mission and vision. Assists in the creation, plan and implementation of internal wellness programs."]
[null,"2145","Nurse Practitioner - Case Management","Case Management","Provides assistance and support to the case management staff. Assists staff in problem solving, technical support, and proactive case management skill building. Participates in creating patient care models. Must be formally trained as a nurse practitioner."]
[null,"2146","External Wellness Coach - Senior","External Wellness","Under general direction, supports health promotion and disease prevention and care management services to the plan's members. Explains, educates, reinforces, and coaches members on their tailored self-help plans. Identifies problems, sets goals, and determines the individual's health status based on assessment. Establishes goals for each individual regarding educational and health care needs. Communicates with primary care and/or treating physician to request specific health information and/or to provide an update of an individual's health care status. Typically requires education/certification/licensure other than an RN, such as BSW, MSW, Respiratory Therapist, Dietician, Nutritionist, or Occupational Therapist. Typically has more than three years of experience in claims and customer service."]
[null,"2147","External Wellness Coach - Associate","External Wellness","Under direct supervision, supports health promotion and disease prevention and care management services to the plan's members. Explains, educates, reinforces, and coaches members on their tailored self-help plans. Identifies problems, sets goals, and determines the individual's health status based on assessment. Establishes goals for each individual regarding educational and health care needs. Communicates with primary care and/or treating physician to request specific health information and/or to provide an update of an individual's health care status. Typically requires education/certification/licensure other than an RN, such as BSW, MSW, Respiratory Therapist, Dietician, Nutritionist, or Occupational Therapist. Typically has less than three years of experience in claims and customer service.","D"]
[null,"2148","Social Worker (LCSW)","Case Management","Responsible for providing guidance to members regarding barriers to managing health conditions. Conducts outbound telephone calls to members to provide health coaching and consultation. Assists members to change behaviors and to locate and access interpersonal, family and community resources that will make it easier to manage their health. Provides consultation to staff members regarding methods/approaches to help participants recognize and overcome barriers to better health. Requires LCSW certification."]
[null,"2149","Social Worker","Case Management","Responsible for providing guidance to members regarding barriers to managing health conditions. Conducts outbound telephone calls to members to provide health coaching and consultation. Assists members to change behaviors and to locate and access interpersonal, family and community resources that will make it easier to manage their health. Provides consultation to staff members regarding methods/approaches to help participants recognize and overcome barriers to better health. Requires a BSW (Bachelor's of Social Work) degree but is unlicensed."]
[null,"2150","Director, Health Data Analysis","Health Data Analysis","Directs the development of health data strategic plans, policies, and procedures for utilization and cost containment information. Directs the analysis, preparation, and presentation of outcomes using health care claims data, pharmacy data, and lab data. Directs the development of data reports and/or products that will enhance the retention of current market share and attract new business by demonstrating cost containment. Interacts with the Information Systems (IS) department extensively. Typically has seven or more years of experience in health data analysis with three to five years of management experience."]
[null,"2151","Long Term Supports & Services (LTSS) Case Manager","Case Management","Responsible for the patients' health related needs by facilitating timely access to care, and educating patients and their families on improving overall health. Assumes the role of primary point of contact for the patient. Develops a plan to ensure each patient's care and builds strong relationships with patients in order ensure their needs and wishes are met. Typically the patient's Long Term Supports and Services (LTSS) are paid by Medicaid. Typically requires a Bachelor's of Social Work or related field and state licensing.","T"]
[null,"2155","Manager, Health Data Analysis","Health Data Analysis","Manages the production and development of utilization and cost containment information. Manages the analysis and preparation of outcomes using health care claims data, pharmacy data, and lab data. Participates in the development of data reports and/or products that will enhance the retention of current market share and attract new business by demonstrating cost containment. Interacts with the Information Systems (IS) department. Responsible for hiring, training, and firing staff. Typically has six or more years of experience in health data analysis with two to three years of supervisory experience."]
[null,"2160","Health Data Analyst - Senior","Health Data Analysis","Under general direction, performs research and analysis of complex health care claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents health care utilization and cost containment reports and makes recommendations based on relevant findings. May provide guidance or expertise to less experienced analysts. Typically requires five or more years of experience in health data analysis."]
[null,"2163","Health Data Analyst - Intermediate","Health Data Analysis","Under general supervision, performs research and analysis of complex health care claims, pharmacy, and lab data regarding network utilization and cost containment information. Evaluates, writes, presents, and provides recommendations regarding health care utilization and cost containment reports. May provide guidance or expertise to less experienced analysts. Typically requires three to five years of experience in health data analysis."]
[null,"2165","Health Data Analyst - Associate","Health Data Analysis","Under direct supervision, performs research and analysis of health care claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Assists in evaluating, writing, and presenting health care utilization and cost containment reports. Typically has less than three years of experience in health data analysis."]
[null,"2167","Director, Data Science","Data Science","Directs the design, development and operations of health data into meaningful performance measures and decision supported approaches. Typically has seven or more years of experience in data science with three to five years of management experience. Typically holds a Ph.D. in a quantitative/research discipline."]
[null,"2168","Manager, Data Science","Data Science","Manages the health data science group that conducts research, and develops tools and processes that improve the outcomes, quality, access to, cost, and management of health care to members. Recruits, hires, trains, and coaches staff with very high level analytical and technical skills. Typically holds a Ph.D. in a quantitative/research discipline. Normally reports to Director, Data Science."]
[null,"2170","Data Scientist - Senior","Data Science","Under general direction, provides consultation on the design, testing, and enhancement of reporting systems. Researches, manipulates, and prepares data related to health management programs that document program activities and the results of health management interventions. Typically includes creating various machine learning-based tools or processes within the company, such as recommendation engines or automated lead scoring systems. Performs statistical analysis to build Artificial Intelligence tools that automate certain processes within the company and create data science algorithms (e.g. regression, classification and clustering techniques, decision trees and random forests, machine learning techniques like supervised, unsupervised and reinforcement learning). Typically has five or more years of experience in data science and holds a Ph.D. in a quantitative/research discipline. Normally reports to Manager, Data Science.","D"]
[null,"2173","Data Scientist - Intermediate","Data Science","Under general supervision, provides consultation on the design, testing, and enhancement of reporting systems. Researches, manipulates, and prepares data related to health management programs that document program activities and the results of health management interventions. Typically includes creating various machine learning-based tools or processes within the company, such as recommendation engines or automated lead scoring systems. Performs statistical analysis to build Artificial Intelligence tools that automate certain processes within the company and create data science algorithms (e.g. regression, classification and clustering techniques, decision trees and random forests, machine learning techniques like supervised, unsupervised and reinforcement learning). Typically has three to five years of experience in data science and holds a Ph.D. in a quantitative/research discipline. Normally reports to Manager, Data Science.","D"]
[null,"2175","Data Scientist - Associate","Data Science","Under direct supervision, provides consultation on the design, testing, and enhancement of reporting systems. Researches, manipulates, and prepares data related to health management programs that document program activities and the results of health management interventions. Typically includes creating various machine learning-based tools or processes within the company, such as recommendation engines or automated lead scoring systems. Performs statistical analysis to build Artificial Intelligence tools that automate certain processes within the company and create data science algorithms (e.g. regression, classification and clustering techniques, decision trees and random forests, machine learning techniques like supervised, unsupervised and reinforcement learning). Typically has less than three years of experience in data science and holds a Ph.D. in a quantitative/research discipline. Normally reports to Manager, Data Science.","D"]
[null,"2176","Bio-Statistician","Data Science","Uses advanced statistical and computational methodologies to deliver insights and strategic opportunities to improve the clinical outcomes, quality, and cost of health care. Analyzes large data sets from various sources in order to create predictive models and evaluate trends. Designs and performs reports and statistical analyses, and then explains this analysis to a non-technical audience of both internal and external customers including senior management and physicians. Educates and communicates with business users regarding the impact and application of advanced statistical methods to health care data. Typically has five year or more years of experience and holds a Ph.D. in a quantitative/research discipline."]
[null,"2178","IT Scrum Master","Data Science","Responsible for facilitating projects and guides cross functional teams in executing the principles of the Scrum framework. Acts as a servant leader to the team, and facilitates planning, team learning in the form of reviews and retrospectives, and adaptation of the process to ensure quality of team/solutions. Ensures the tracking and reporting of daily activities. Responsible for removing impediments that prevent a team from completing the work it has negotiated for a given sprint. Has experience in business analysis, product/project management, or product development. Typically has Scrum Master Certification (CSM) and/or experience using Agile methods."]
[null,"2179","Account Installation Manager/Supervisor","Client Account Installation","Manages the account installation project for clients. Coordinates with the client as well as the internal installation team. Ensures that the installation of assigned accounts, including, but not limited to: structure and billing set up, eligibility collection, database loading, and preparation of plan materials such as administrative documents and customer education materials are done on schedule and according to the project plan. Provides support to assigned accounts by responding to inquiries and resolving issues of concern. Typically has three or more years of related experience.","T"]
[null,"2180","Account Installation Specialist - Senior","Client Account Installation","Under general direction, administers the installation of assigned accounts, including, but not limited to: structure and billing set up, eligibility collection, database loading, and preparation of plan materials such as administrative documents and customer education materials. Provides support to assigned accounts by responding to inquiries and resolving issues of concern. May provide guidance or expertise to less experienced representatives. Typically has three or more years of related experience."]
[null,"2182","Account Installation Specialist - Associate","Client Account Installation","Under direct supervision, administers the installation of assigned accounts, including, but not limited to: structure and billing set up, eligibility collection, database loading, and preparation of plan materials such as administrative documents and customer education materials. Provides support to assigned accounts by responding to inquiries and resolving issues of concern. Typically has less than three years of related experience."]
[null,"2183","Director, Client Services","Client Services","Directs the client services group to meet operational, financial, and service requirements. Develops and executes strategic and operational business plans for the department. Coordinates department operations and modifications with other areas of the organization. Typically holds a Bachelor's degree and has seven or more years of experience in client services with three to five years of management experience."]
[null,"2184","Manager, Client Services","Client Services","Responsible for the daily operations of the client services group. Directs staff on procedures. Analyzes causes of member inquiries. Responsible for hiring, training, and firing of staff. Typically holds a Bachelor's degree and has six or more years of experience with two to three years of supervisory experience. Normally reports to the Director, Client Services."]
[null,"2186","Client Services Representative - Senior","Client Services","Under general direction, investigates, analyzes and develops creative solutions to client specific problems related to systems, claims, networks, providers, eligibility, billing, collections, etc. through active cross-functional team participation. Provides information to enrollment and account installation staff. Monitors set up of account files and ensures proper billing. May provide guidance or expertise to less experienced representatives. Typically has three or more years of experience. NOTE: If the incumbent is an account manager, please see Module 3, positions 3210-3215."]
[null,"2188","Client Services Representative - Associate","Client Services","Under direct supervision, investigates, analyzes and develops creative solutions to client specific problems related to systems, claims, networks, providers, eligibility, billing, collections, etc. through active cross-functional team participation. Provides information to enrollment and account installation staff. Monitors set up of account files and ensures proper billing. Typically has less than three years of experience. NOTE: If the incumbent is an account manager, please see Module 3, positions 3210-3215."]
[null,"2205","Administrative Director of Utilization Review (non-MD)","Utilization and Medical Claims Review","Directs the utilization review function ensuring accurate and timely prior authorization of designated health care services, concurrent review activity, and retrospective review activity. Responsible for the planning and decision-making related to utilization review. Develops and implements policies and procedures for the utilization review department. Typically requires a RN with clinical and managed care experience. Typically has seven or more years of experience in utilization review with three to five years of management experience."]
[null,"2210","Manager, Utilization Review","Utilization and Medical Claims Review","Coordinates and manages the utilization review function ensuring accurate and timely prior authorization of designated health care services, concurrent review activity, and retrospective review activity. Typically requires a RN with clinical and managed care experience. Typically has six or more years of experience in utilization review analysis with two to three years of supervisory experience."]
[null,"2215","Manager, Medical Claims Review","Utilization and Medical Claims Review","Responsible for the performance, productivity, and quality of the medical review staff. Oversees process improvement implementation. Serves as a technical resource/support for all medical review staff. Responsible for hiring, training, and firing staff. Typically requires a RN or BSN with six or more years of clinical and medical review experience and two to three years of supervisory experience."]
[null,"2220","RN Medical Management - Senior","Utilization and Medical Claims Review","Responsible for collaborating with health care providers and members to optimize member benefits and to promote effective use of resources. Also responsible for the application of medical and reimbursement policies within the claim adjudication process. Assesses the medical necessity of inpatient admissions, outpatient services, surgical and diagnostic procedures, and out of network services. May also manage appeals for services denied and conduct pre-certification, concurrent, and retrospective reviews to ensure compliance with medical policy, member eligibility, benefits, and contracts. Requires RN license and more than five years of related experience."]
[null,"2223","RN Medical Management - Intermediate","Utilization and Medical Claims Review","Responsible for collaborating with health care providers and members to optimize member benefits and to promote effective use of resources. Assesses the medical necessity of inpatient admissions, outpatient services, surgical and diagnostic procedures, and out of network services. May also manage appeals for services denied. May conduct pre-certification, concurrent, and retrospective reviews to ensure compliance with medical policy, member eligibility, benefits, and contracts. Requires RN license and three to five years of related experience."]
[null,"2225","RN Medical Management - Associate","Utilization and Medical Claims Review","Responsible for collaborating with health care providers and members to optimize member benefits and to promote effective use of resources. Assesses the medical necessity of inpatient admissions, outpatient services, surgical and diagnostic procedures, and out of network services. May also manage appeals for services denied. May conduct pre-certification, concurrent, and retrospective reviews to ensure compliance with medical policy, member eligibility, benefits, and contracts. Requires RN license and less than three years of related experience."]
[null,"2230","LPN, Medical Management","Utilization and Medical Claims Review","Under general direction, responsible for collaborating with health care providers and members to optimize member benefits and to promote effective use of resources. Assesses the medical necessity of inpatient admissions, outpatient services, surgical and diagnostic procedures, and out of network services. May also manage appeals for services denied. May conduct pre-certification, concurrent, and retrospective reviews to ensure compliance with medical policy, member eligibility, benefits, and contracts. Requires LPN license and more than three years of related experience."]
[null,"2231","Utilization Management Representative (non-RN)","Utilization and Medical Claims Review","Under general supervision, determines contract and benefit eligibility; provides authorization for inpatient admission and outpatient precertification and/or prior authorization requests. Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. Responds to telephone and written inquiries from clients, providers and in-house departments. Typically has three or more years of experience."]
[null,"2233","Dental Analyst","Utilization and Medical Claims Review","Investigates appropriate utilization of dental services based on contractual benefits and medical circumstances. Conducts review and analysis of claims and confidential dental records to determine appropriate coverage. Determines network status of providers and satisfaction of applicable waiting periods. Represents department on multi-departmental dental committees and makes procedural recommendations. Prepares documentation for and consults with dental and medical consultants concerning customer appeals and complex or unusual requests for coverage. Typically is a Certified Dental Assistant with three years of clinical experience and has extensive knowledge of dental claims coding."]
[null,"2237","Transplant Review Specialist","Utilization and Medical Claims Review","Reviews transplant cases for medical necessity and appropriateness against clinical guidelines. Typically requires a BSN degree with related clinical experience."]
[null,"2240","Director, Special Investigations Unit","Fraud Prevention/Investigation","Responsible for planning, organizing, and controlling the activities of cross-functional employees engaged in the detection and elimination of fraudulent behavior. Prepares comprehensive investigative reports and analyses pertinent to evidence obtained in investigations. Coordinates information and action with law enforcement agencies at the local, state, and federal level. Typically requires five or more years of experience in health care and three years of management experience."]
[null,"2241","Provider Auditor","Auditing","Accesses billing databases to perform comprehensive research and identify billing abnormalities, questionable billing practices, and/or irregularities. Investigates, researches, and analyzes claims data applying knowledge of medical policy to determine details of fraudulent or abusive billing activity. Conducts internal and on-site audits of provider records, clinical records, and itemized bills so as to ensure appropriateness of billing practices and application of medical policy. Identifies and documents fraudulent or erroneous activity during an audit. Typically has a health care background with a Bachelor's degree or licensure in a health-related field and three years of clinical experience with claims and auditing experience."]
[null,"2242","Contract Compliance Representative","Fraud Prevention/Investigation","Responsible for determining provider compliance throughout a state and recommending appropriate action, assisting in special investigations, and providing support in compliance with requests from enforcement agencies. Analyzes documentation and information and summarizes data gathered from a variety of sources. Oversees random examination process, enforcing membership actions, and assessing reports on provider groups or brokers. Conducts ad hoc investigations. Typically requires a degree in math, economics, or a related field and three years of underwriting experience."]
[null,"2243","Nurse Quality Auditor","Auditing","Responsible for developing, conducting, and analyzing quality studies according to criteria developed by management, external review organizations, and other regulatory agencies. Conducts on-site provider audits and researches provider clinical quality issues. Develops and monitors corrective actions, maintains hospital quality database via requests for information and questionnaires, generates scorecards for each hospital, and provides feedback to practitioners on performance. Requires RN license and three years of related experience."]
[null,"2245","Administrative Director of Quality Management (non-MD)","Quality Management","Directs the overall quality management program. Responsible for the analysis of the quality of member care received and for the development of plans and programs to support continuous quality improvement. Establishes strategic plans, policies, and procedures at all levels and with all or critical operation departments to ensure quality programs will meet or exceed guidelines or requirements. Typically requires a RN with seven or more years of clinical and managed care experience and three to five years of management experience."]
[null,"2250","Manager, Quality Management","Quality Management","Establishes and maintains a system that evaluates the quality of member care. Serves as a resource regarding accreditation standards including NCQA standards and continuous quality improvement principles. May coordinate accreditation activities on behalf of the organization. Responsible for hiring, training, and firing staff. Typically requires a RN with six or more years of clinical and managed care experience with two to three years of supervisory experience."]
[null,"2255","Quality Management Analyst - Senior","Quality Management","Under general direction, responsible for the identification of complex quality issues through analyzing data and preparing reports. Develops possible solutions to quality management issues and may design and implement processes necessary to make these changes. May provide guidance or expertise to less experienced analysts. Typically has three or more years of related experience."]
[null,"2260","Quality Management Analyst - Associate","Quality Management","Under general supervision, obtains and analyzes data and assists in preparing reports used in identifying quality management issues. Assists in the development of possible solutions to quality management issues. May design and implement processes necessary to make these changes. Typically has less than three years of related experience."]
[null,"2265","Training and Quality Nurse Specialist","Quality Management","Conducts extensive training on managed care principles, automated systems, department policies and procedures, and work processes to new employees. Develops and manages in-service educational programs for all staff when internal workflow changes occur and maintains training and policy and procedures manuals. Also responsible for performing quality reviews of department staff and overall programs. Assists staff in problem-solving, technical support, and proactive case management skill-building. Requires a RN with typically three to five years of clinical nursing experience and at least two years of experience in managed care."]
[null,"2267","Clinical Quality Management Nurse - Senior","Quality Management","Responsible for working with appropriate departments in the areas of compliance, process improvement, and member/provider satisfaction for all product lines. Reviews, researches and responds to customer complaints relating to quality of medical care and service. Recommends and/or implements process improvements related to the potential quality of medical care and service. Requires RN license and five or more years of related experience."]
[null,"2268","Clinical Quality Management Nurse - Associate","Quality Management","Responsible for working with appropriate departments in the areas of compliance, process improvement, and member/provider satisfaction for all product lines. Reviews, researches and responds to customer complaints relating to quality of medical care and service. Recommends and/or implements process improvements related to the potential quality of medical care and service. Requires RN license and three or more years of related experience."]
[null,"2270","Fraud Investigator - Senior","Fraud Prevention/Investigation","Under general direction, independently conducts investigations of allegations of fraudulent and abusive practices. Coordinates investigation with law enforcement authorities. Assembles evidence and documentation to support successful adjudication, where appropriate. Conducts on-site audits of provider records ensuring appropriateness of billing practices. Prepares complex investigative and audit reports. May provide guidance to less experienced investigators. Typically requires a Bachelor's degree in criminal justice, accounting, nursing, or a related field and five years of investigative experience in criminal justice involving white-collar crime or health care fraud."]
[null,"2275","Fraud Analyst/Investigator - Associate","Fraud Prevention/Investigation","Under direct supervision, researches and analyzes complaints of irregular billing activity to identify a wide range of abusive practices from simple to complex schemes that result in unjustifiable expenditures and/or criminal activity. Conducts accurate and detailed audits from review of billing, clinical, and other records comparing them with company contracts and policies. Determines actual overpayment that may have occurred. Typically requires an Associate's degree in accounting, law enforcement, nursing or other health care field and is licensed or certified as a health care professional (e.g., LPN, Physician Assistant).","D"]
[null,"2280","Director, Health Promotion/Education","Health Promotion/Education","Directs the establishment, management, and maintenance of current health care information that will assist staff education and outreach programs. Also, may be responsible for developing and implementing various health education programs and materials that satisfy the needs and interests of plan enrollees, employers, and providers. Monitors, assesses, and reviews educational programs for effectiveness. Typically requires seven or more years of related experience with three to five years of management experience."]
[null,"2285","Manager, Health Promotion/Education","Health Promotion/Education","Establishes, manages, and maintains current health care information that will assist staff education and outreach programs. Also, responsible for the development and implementation of various health education programs and materials that satisfy the needs and interests of members, employers, and providers. Assists in the monitoring and assessment of educational programs and needs. Oversees the referrals to external education programs and community resources. Manages the daily functions for the health education department. Responsible for hiring, training, and firing staff. Typically requires six or more years of related experience with two to three years of supervisory experience."]
[null,"2290","Health Promotion/Education Specialist - Senior","Health Promotion/Education","Under general direction, develops, promotes, and presents health education programs and materials that satisfy the needs and interests of plan members, employers, and providers. Works with various internal and external parties in conducting needs assessments and designing health education programs. Coordinates referrals to outside programs. May provide guidance or expertise to less experienced specialists. Typically has three or more years of related experience."]
[null,"2295","Health Promotion/Education Specialist - Associate","Health Promotion/Education","Under direct supervision, assists in the development, promotion, and presentation of health education programs that satisfy the needs and interests of members, employers, and providers. May coordinate referrals to outside programs. Typically has less than three years of related experience.","D"]
[null,"2300","Director, Case Management - Behavioral Health","Behavioral Health","Provides leadership and directs the inpatient and outpatient case management program of the behavioral health unit. Oversees behavioral health initiatives and direction that support safe, aggressive treatment resulting in quality outcomes and cost-effective care. Ensures appropriate utilization management through comprehensive direction and supervision of operational staff. Typically reports to the Top Behavioral Health Executive. Typically requires seven or more years of related experience and three to five years of management experience."]
[null,"2305","Manager/Supervisor, Case Management - Behavioral Health","Behavioral Health","Provides administrative and clinical supervision, as well as team leadership, to the case management team of the behavioral health unit. Manages the operations of a case management team and assists with operations planning and monitoring. Monitors and evaluates case managers' performance, efficiency, and productivity according to quality management standards and performance guarantees. Manages team performance including goal-setting, multi-source feedback, measurement, and performance related rewards. Typically requires five or more years of related experience with two to three years of supervisory experience."]
[null,"2310","Case Manager - Behavioral Health - Senior","Behavioral Health","Under general direction, provides case management services for the behavioral health unit through evaluation and review of inpatient and outpatient behavioral health treatments for medical necessity, emergency status, and quality of care. Provides direction to network providers on best use of benefit provisions and quality compliance issues. Reviews and certifies complex treatment plans. May conduct 24-hour crisis counseling. May provide guidance or expertise to less experienced case managers. Requires RN license or licensed clinician (with Masters degree) and three or more years of clinical behavioral health experience and experience as a case manager."]
[null,"2315","Case Manager - Behavioral Health - Associate","Behavioral Health","Under direct supervision, provides case management services for the behavioral health unit through evaluation and review of inpatient and outpatient behavioral health treatments for medical necessity, emergency status, and quality of care. Provides direction to network providers on best use of benefit provisions and quality compliance issues. Reviews and certifies treatment plans. May conduct 24-hour crisis counseling. Requires RN license or licensed clinician (with Masters degree) and less than three years of clinical behavioral health experience.","D"]
[null,"2320","Quality Improvement Coordinator - Behavioral Health","Behavioral Health","Coordinates and manages quality improvement initiatives for the behavioral health unit. Identifies opportunities for internal and external quality improvement and develops strategies and programs to address the same. Develops and manages information systems to support and improve the unit's strategic planning, operations, medical management, and financial success. Develops and processes all reports needed for the unit. Presents information formally and informally at internal and external forums. Typically requires a Master's degree, a clinical or human services degree, and five years of quality management experience."]
[null,"2330","Supervisor Intake - Behavioral Health","Behavioral Health","Provides management for the intake group of a behavioral health network. Selects and develops intake and administrative staff for the intake group of a behavioral health network. Orients and trains employees on telephone and computer systems, as well as policies and procedures. Measures and reports customer service results against company standards. Typically requires three or more years of related experience."]
[null,"2335","Intake Coordinator - Behavioral Health","Behavioral Health","Assigns client to appropriate staff member or behavioral health network provider for assessment and counseling. Serves as initial contact for clients and their eligible dependents requesting services. Responsible for customer service and relevant standards such as telephone response time. May make referrals within stated limits."]
[null,"2400","Director, Actuarial Services","Actuarial Services","Directs the actuarial functions of the organization. Oversees the monitoring, evaluating, and reporting of the effectiveness of the existing rating formula. Approves prospect and renewal rates for experience-rated categories of business. Advises management in the selection of major rating assumptions. Provides support to the marketing division by participating in the development of new products and meeting with key accounts to present rating/financial information. Typically holds a Bachelor's degree in mathematics, statistics, or actuarial science with seven or more years of actuarial experience in a high level technical or managerial position."]
[null,"2405","Manager, Actuarial Services","Actuarial Services","Responsible for a group of actuaries that performs financial projections and actuarial analysis. Implements policy to protect the organization's financial integrity. May be responsible for pricing, risk management, reserving, and actuarial administration. Identifies critical issues and recommends solutions to business problems. Responsible for hiring, training, and firing staff. Typically holds a Bachelor's degree in mathematics, statistics, or actuarial science and has actuarial experience."]
[null,"2410","Senior Actuarial Consultant (FSA)","Actuarial Services","Under general direction, performs financial projections and actuarial analysis for multiple projects or complex assignments. Recommends policies to protect the organization's financial integrity. May oversee the professional work of lower level actuaries. Typically holds a Bachelor's degree in mathematics, statistics, or actuarial science and belongs to the Society of Actuaries with the designation of FSA (Fellow)."]
[null,"2413","Actuarial Consultant (ASA+)","Actuarial Services","Under general supervision, establishes insurance rates, rating structures, and rating systems for groups and categories. Compiles, analyzes, and develops essential statistical data for current and future actuarial studies. Assists in the performance of financial projections and actuarial analysis for one or more well-defined projects. Typically holds a Bachelor's degree in mathematics, statistics, or actuarial science and belongs to the Society of Actuaries with the designation of ASA (Associate) and is pursuing the designation of FSA (Fellow)."]
[null,"2415","Actuarial Analyst (ASA)","Actuarial Services","Under general supervision, establishes insurance rates, rating structures, and rating systems for groups and categories. Compiles, analyzes, and develops essential statistical data for current and future actuarial studies. Assists in the performance of financial projections and actuarial analysis for one or more well-defined projects. Typically holds a Bachelor's degree in mathematics, statistics, or actuarial science and belongs to the Society of Actuaries with the designation of ASA (Associate)."]
[null,"2418","Actuarial Analyst - Senior","Actuarial Services","Assists in the determination of rates. Analyzes, develops, and validates statistical data. Typically holds a Bachelor's degree in mathematics, statistics, or actuarial science and has more than four years experience. Must be currently pursuing the designation of ASA (Associate) in the Society of Actuaries with the completion of more than four exams."]
[null,"2420","Actuarial Analyst - Intermediate","Actuarial Services","Assists in the determination of rates. Analyzes, develops, and validates statistical data. Typically holds a Bachelor's degree in mathematics, statistics, or actuarial science and has two to four years experience. Must be currently pursuing the designation of ASA (Associate) in the Society of Actuaries with the completion of three to five exams."]
[null,"2422","Actuarial Analyst - Associate","Actuarial Services","Assists in the determination of rates. Analyzes, develops, and validates statistical data. This is an entry-level actuarial position. Typically holds a Bachelor's degree in mathematics, statistics, or actuarial science and has less than two years experience. Must be currently pursuing the designation of ASA (Associate) in the Society of Actuaries with the completion of up to three exams."]
[null,"2430","Director, Medical Underwriting","Underwriting: Medical Underwriting","Develops policies and procedures for the medical underwriting staff. Monitors corporate language to ensure proper reflection of risk underwritten in the development of general proposal packages. Develops master policies and other official documents. Executes account contracts to be in compliance with federal and state laws. Typically is a RN with clinical experience and has seven or more years of underwriting experience with three to five years of management experience."]
[null,"2435","Manager, Medical Underwriting","Underwriting: Medical Underwriting","Manages the medical underwriting staff. Responsible for the accurate application of underwriting policies and procedures. Assists in the development of master policies and other official documents. Ensures that the account contracts are in compliance with government regulations. Responsible for hiring, training, and firing staff. Typically is a RN with clinical experience and has six or more years of underwriting experience."]
[null,"2440","Medical Underwriter - Senior","Underwriting: Medical Underwriting","Under general direction, performs complex medical underwriting functions. Establishes criteria for acceptance of applicants based on prior medical history, current health status, prognosis, and anticipated future medical costs. May provide guidance or expertise to less experienced underwriters. Typically is a RN with three or more years of medical underwriting experience."]
[null,"2445","Medical Underwriter - Associate","Underwriting: Medical Underwriting","Under direct supervision, performs medical underwriting functions. Establishes criteria for acceptance of applicants based on prior medical history, current health status, prognosis, and anticipated future medical costs. Typically is a RN with less than three years of medical underwriting experience.","D"]
[null,"2450","Director, Group Underwriting","Underwriting: Group Underwriting","Develops policies and procedures for the group underwriting staff. Develops and monitors department policies and provides underwriting support to other areas within the organization. Typically holds a Bachelor's degree in mathematics or finance and has seven or more years of underwriting experience with three to five years of management experience."]
[null,"2455","Manager, Group Underwriting","Underwriting: Group Underwriting","Manages the group underwriting staff and defines and controls the rate-setting process. Develops and monitors policies and procedures for group underwriting. May provide underwriting support to other areas within the organization. Responsible for hiring, training, and firing staff. Typically holds a Bachelor's degree in mathematics or finance and has six or more years of underwriting experience."]
[null,"2460","Group Underwriter - Senior","Underwriting: Group Underwriting","Under general direction, computes rates for both renewing and prospective complex/large group accounts. Prepares a variety of financial reports for large accounts and provides rationale and support to other areas within the organization and to clients regarding rate computations and financial activity. Provides expense estimates and accurate analysis of financial exhibits. May provide guidance or expertise to less experienced underwriters. Typically holds a Bachelor's degree in mathematics or finance and has five or more years of related experience."]
[null,"2463","Group Underwriter - Intermediate","Underwriting: Group Underwriting","Under general supervision, computes rates for both renewing and prospective moderate to complex group accounts. Prepares a variety of financial reports for large accounts and provides rationale and support to other areas within the organization and to clients regarding rate computations and financial activity. Provides expense estimates and accurate analysis of financial exhibits. Typically holds a Bachelor's degree in mathematics or finance and has three to five years of related experience."]
[null,"2465","Group Underwriter - Associate","Underwriting: Group Underwriting","Under direct supervision, computes rates for both renewing and prospective least complex group accounts. Prepares a variety of financial reports for group accounts and provides rationale and support to other areas within the organization and to clients regarding rate computations and financial activity. Typically holds a Bachelor's degree in mathematics or finance and has less than three years of related experience."]
[null,"2470","Rating/Pricing Analyst - Senior","Underwriting: Pricing","Under general direction, provides complex benefits plan and medical cost analysis. Prepares scheduled account reports and projects as requested. Monitors and analyzes cost trends. May provide guidance or expertise to less experienced analysts. Typically holds a Bachelor's degree with heavy concentration in mathematics or statistics and has three or more years of experience in pricing."]
[null,"2475","Rating/Pricing Analyst - Associate","Underwriting: Pricing","Under general supervision, assists in providing benefits plan and medical cost analysis, maintains databases, and prepares scheduled account reports and projects as requested. Typically holds a Bachelor's degree with heavy concentration in mathematics or statistics and has less than three years of related experience."]
[null,"2479","Director, Risk Management","Risk Management","Responsible for development and coordination of the organization's risk management programs. Analyzes risk of potential losses in property, funds, and/or claims processing. Determines methods of insurance and negotiates with insurance carriers. Responsible for establishing standards and overseeing loss and prevention policies and procedures."]
[null,"2480","Manager, Risk Management","Risk Management","Responsible for the management of the risk management staff. Designs and implements programs to control company losses and to transfer and/or finance risk protocols that will minimize the adverse financial impact of risk to the organization. Utilizes financial and actuarial skills to analyze risk insurance market trends and alternative financing options. Typically has five to six years of related experience. Normally reports to Director, Risk Management."]
[null,"2485","Risk Management Analyst - Senior","Risk Management","Works with business areas to administer exposure policies and loss control programs. Oversees and finances risks and legal liability for exposures. Conducts root cause analysis on major risk/claims issues. Reviews lease agreements, management agreements, vendor contracts, and policies and procedures to identify risks and provide recommendations for minimizing exposures to losses. Typically has three to five years of related experience."]
[null,"2490","Risk Management Analyst - Associate","Risk Management","Provides technical support for timely and effective insurance, claims, and risk financing for the risk management program. Ensures compliance with state regulations and prepares summary claims reports. Identifies options and provides recommendations for the design and development of risk management information systems. Utilizes data management and spreadsheet capabilities to assist in identifying loss trends, administering current programs, and responding to customer requests. Typically has less than three years of related experience."]
[null,"2493","Director, Risk Adjustment","Risk Adjustment","Responsible for the risk adjustment analytics department. Leads analytical support for Medicare, Medicaid, and Commercial-ACA risk adjustment programs. Drives the strategy and development of risk adjustment analytic solutions, oversee execution, and measure results. Responsible for optimizing revenue integrity and accuracy under the applicable Federal and State risk adjustment systems. Typically has seven or more years of contracting experience and three to five years of management experience.","N"]
[null,"2495","Manager, Risk Adjustment","Risk Adjustment","Responsible for monitoring the revenue that the organization is making off the health exchanges, individual and small group health insurance markets, Medicaid and Medicare to ensure that they will not have to reimburse the government. Responsible for modifying premium payments to better reflect the projected costs of members served and compensate plans that enroll high-cost patient; in effect, redistributing some revenue from health or drug plans with a relatively healthier mix of members to those plans with a more costly enrollment profile. Risk Adjustment is also referred to as Revenue Program Management and is charged with accurately reporting each member's health status and risk profile to either CMS or HHS. Through these activities, ensures their organization receives the appropriate government revenue for each member's health and risk status and positively contributes to improving its quality scores through STARS and HEDIS measurements.","T"]
[null,"2497","Risk Adjustment/Revenue Analyst - Senior","Risk Adjustment","Under general direction, performs analysis and implement procedures which ensure the accuracy of data submitted to government agencies for determining risk adjustment payments. Conduct risk adjustment data validation and audits to identify and resolve data integrity issues. Analyze provider coding trends to detect risk gaps and opportunities for provider education. Risk Adjustment is also referred to as Revenue Program Management and is charged with accurately reporting each member's health status and risk profile to either CMS or HHS. Through these activities, ensures their organization receives the appropriate government revenue for each member's health and risk status and positively contributes to improving its quality scores through STARS and HEDIS measurements. Typically requires three or more years of related experience."]
[null,"2498","Risk Adjustment/Revenue Analyst - Associate","Risk Adjustment","Under direct supervision, performs analysis and implement procedures which ensure the accuracy of data submitted to government agencies for determining risk adjustment payments. Conduct risk adjustment data validation and audits to identify and resolve data integrity issues. Analyze provider coding trends to detect risk gaps and opportunities for provider education. Risk Adjustment is also referred to as Revenue Program Management and is charged with accurately reporting each member's health status and risk profile to either CMS or HHS. Through these activities, ensures their organization receives the appropriate government revenue for each member's health and risk status and positively contributes to improving its quality scores through STARS and HEDIS measurements. Typically requires less than three years of related experience.","D"]
[null,"2500","Director, Provider Network Management","Provider Network Management","Responsible for the management of the provider network, which may include network development, contracting, credentialing, provider relations, and provider services. May also be responsible for providing policy administration for provider networks and ensuring contractual compliance with government regulations. Typically has seven or more years of related experience and three to five years of management experience."]
[null,"2505","Manager, Provider Network Management","Provider Network Management","Responsible for the daily activities of the provider network staff, which may include network development, contracting, credentialing, provider relations, and provider services. Responsible for hiring, training, and firing staff. Typically has six or more years of related experience."]
[null,"2520","Director, Contracting","Provider Network Contracting","Responsible for the contracting group. Oversees the preparation, analysis, review, and projection of the financial impact of provider contracts and specific terms. Directs the staff that drafts contracts, conducts negotiations, and ensures the smooth operation and administration of provider agreements. Typically has seven or more years of contracting experience and three to five years of management experience."]
[null,"2525","Manager, Contracting","Provider Network Contracting","Responsible for the daily activities of the contracting specialists and support staff related to contracting and facility database management. Oversees facility rate setting and contract language negotiations for facilities identified and solicited by network development staff. Responsible for hiring, training, and firing staff. Typically has six or more years of contracting experience."]
[null,"2528","Provider Engagement Consultant","Provider Network Contracting","Focuses on engaging providers to partner with the health plan in investing in the health of the patients in the providers' care. Typically includes risk contracts that incent or reward the provider for taking on more ownership/risk for the health of the patients. This position is related to the provider contractor but is not the traditional provider contracting model."]
[null,"2530","Contracting Specialist - Senior","Provider Network Contracting","Under general direction, prepares, analyzes, reviews, and projects financial impact of large or complex provider contracts and alternate contract terms. Conducts negotiations and drafts individual contracts. Ensures the smooth operation and administration of provider agreements. May provide guidance or expertise to less experienced specialists. Typically requires a Bachelor's degree in a related area with five or more years of related experience."]
[null,"2533","Contracting Specialist - Intermediate","Provider Network Contracting","Under general supervision, prepares, analyzes, reviews, and projects financial impact of large or complex provider contracts and alternate contract terms. Conducts negotiations and drafts individual contracts, and ensures the smooth operation and administration of provider agreements. May provide guidance or expertise to less experienced specialists. Typically requires a Bachelor's degree with three to five years of related experience."]
[null,"2535","Contracting Specialist - Associate","Provider Network Contracting","Under direct supervision, prepares, analyzes, reviews, and projects financial impact of provider contracts. Drafts contracts and conducts pre-contractual audits and surveys. May negotiate or assist in negotiating individual contracts. Typically requires a Bachelor's degree in a related area with less than three years of related experience."]
[null,"2537","Hospital Contracting Expert","Provider Network Contracting","Performs as lead negotiator for large, strategic, complex contracting efforts with hospitals and health care systems as well as provide comprehensive contract drafting and language negotiation oversight and guidance to the contracting team. Requires solid understanding of business and legal principals and extensive experience in performing these types of duties with business contracts. May train/mentor ancillary/provider contractors. Typically requires a Bachelor's degree in a related area with five or more years of related experience."]
[null,"2538","Hospital Contracting Specialist","Provider Network Contracting","Negotiates and drafts individual contracts with hospitals and health care systems. Prepares, analyzes, reviews, and projects financial impact of large, complex contracts with hospitals. Ensures the smooth operation and administration of provider agreements. May train/mentor ancillary/provider contractors. Typically requires a Bachelor's degree in a related area with three to five years of related experience."]
[null,"2539","Director, Credentialing","Provider Network Credentialing","Responsible for the department associated with the credentialing or re-credentialing of physicians and providers. Manages the staff that processes provider applications and re-applications including initial mailing, review, and loading into the database tracking system. Develops credentialing policies and procedures, oversees primary source verification activities, presents files to the credentialing committee, and identifies and analyzes trends on application status for internal and external use. Typically holds a Bachelor's degree and has seven or more years of related experience with three to five years of management experience."]
[null,"2540","Manager, Credentialing","Provider Network Credentialing","Manages all activities associated with credentialing or re-credentialing physicians and providers. Manages the staff that processes provider applications and re-applications including initial mailing, review, and loading into the database tracking system. Responsible for the development of credentialing policies and procedures. Oversees primary source verification activities. Presents files to the credentialing committee. Identifies and analyzes trends on application status for internal and external use. Typically has six or more years of credentialing experience with two years of supervisory experience."]
[null,"2545","Supervisor, Credentialing","Provider Network Credentialing","Supervises activities of the staff performing credentialing or re-credentialing of physicians and providers. Supervises the processing of provider applications and re-applications including the initial mailing, review, and loading. Oversees primary source verification activities and data entry. Typically requires five or more years of related experience."]
[null,"2550","Credentialing Specialist - Senior","Provider Network Credentialing","Under general direction, implements and monitors procedures and activities related to the credentialing, re-credentialing, and privileging of network providers. Processes provider applications and re-applications including initial mailing, review, and loading. Maintains provider profiling system and communicates with providers by phone and mail regarding credentialing status and information. May provide guidance or expertise to less experienced specialists. Typically requires three or more years of related experience."]
[null,"2555","Credentialing Specialist - Associate","Provider Network Credentialing","Under direct supervision, processes provider applications and re-applications including the initial mailing, review, and loading. May assist in the implementation of procedures and activities related to the credentialing, re-credentialing, and privileging of network providers. Maintains provider profiling system and communicates with providers by phone and mail regarding credentialing status and information. Typically requires less than three years of related experience.","D"]
[null,"2556","Director, Provider Installation","Provider Network Installation","Responsible for the development and strategic direction of contracted provider installation. Develops end to end contracting processes, structure, workforce management and staff development/retention. Works with functional operational areas across all regions to ensure processes, metrics and service levels are compliant and to maximize the business segment partner and provider experience. Typically requires a Bachelor's degree and has seven or more years of related experience with three to five years of management experience."]
[null,"2557","Manager, Provider Installation","Provider Network Installation","Responsible for the daily activities of the department handling provider installation. Manages contracting processes, structure, and workforce management. Works with functional operational areas to ensure processes and service levels are compliant. Responsible for meeting organization standards pertaining to contract administration. Manage and establish processes necessary to support the markets/regions including contract issuance and execution, contract maintenance and research and resolution. Typically requires a Bachelor's degree and has six or more years of related experience with two to three years of supervisory experience."]
[null,"2558","Supervisor, Provider Installation","Provider Network Installation","Supervises the activities of the department handling provider installation to ensure standards are met for timely processing of contracted providers, accurate contract loading to all business segment platforms and products, provider maintenance activities, network integration and re-contracting/development initiatives. Reviews and resolves complex service issues and provides expertise and guidance to staff. Typically requires a Bachelor's degree with three or more years of related experience."]
[null,"2559","Provider Installation Analyst","Provider Network Installation","Responsible for administering the installation of assigned provider accounts. Performs set-up, database loading, and preparation of administrative documents and materials. Provides support to provider accounts by responding to inquiries and resolving issues of concern. Typically has three or more years of related experience."]
[null,"2560","Director, Provider Relations","Provider Relations","Directs and implements strategies relating to the development and management of a physician/provider network. Develops programs to recruit, service, train, and reimburse physicians and providers. Designs and implements programs to maintain positive relationships between the health plan, physicians, providers, and practice managers. Typically has seven or more years of related experience and three to five years of management experience."]
[null,"2565","Manager, Provider Relations","Provider Relations","Manages the daily operations for developing and managing the physician/provider network, which includes recruiting, servicing, and training physicians and providers. Implements the programs to maintain positive relationships between the health plan, physicians, providers, and practice managers. Responsible for the hiring, training, and firing of staff. Typically has six or more years of related experience."]
[null,"2567","Supervisor, Provider Relations","Provider Relations","Supervises the activities of the provider relations department which includes recruiting, servicing, and training physicians and providers. Assists with the implementation of programs to maintain positive relationships between the health plan, physicians, providers, and practice managers. Typically requires a Bachelor's degree with three or more years of related experience.","N"]
[null,"2570","Provider Relations Representative - Senior","Provider Relations","Under general direction, develops and maintains positive relationships with physicians, providers, and practice managers within the provider network. Provides high quality service to physicians, providers, and practice managers. May provide guidance or expertise to less experienced representatives. Typically requires a Bachelor's degree in a related area with three or more years of experience in physician relations or managed care."]
[null,"2575","Provider Relations Representative - Associate","Provider Relations","Under direct supervision, develops and maintains positive relationships with physicians, providers, and practice managers within the provider network. Provides high quality service to physicians, providers, and practice managers. Typically requires a Bachelor's degree in a related area with less than three years of experience in health care or managed care.","D"]
[null,"2580","Manager, Medical Policy Management Operations","Medical Policy","Responsible for the management and direction of provider reimbursement strategies. Directs the implementation of medical policy to ensure correct adjudication of claims in accordance with provider contracts, member contracts, legislative acts, and regulatory mandates. Evaluates and recommends medical policy and provider reimbursement guidelines as they relate to control over medical claims cost. Typically holds a Bachelor's degree in business, finance, economics, or health care administration with five years of experience in a managed care or provider environment."]
[null,"2583","Director, Provider Network Database","Provider Network Database","Responsible for the provider network database which maintains current provider data to ensure the quality of the network, coordinates provider enrollment, and assists with coordination of meetings with providers for training, contracting, and reporting. Typically holds a Bachelor's degree and has seven or more years of related experience with three to five of management experience. Typically reports to Top Provider Network Executive."]
[null,"2585","Manager, Provider Network Reimbursement Programs","Provider Network Database","Responsible for provider reimbursement programs, policies, and strategies to ensure unit cost controls meet or exceed corporate objectives for medical cost containment. Analyzes claims, utilization, and medical cost data. Develops strategic, cost effective programs, and makes system or network changes to enhance competitive position."]
[null,"2590","Manager, Provider Network (Database Management)","Provider Network Database","Oversees the maintenance of the provider network database and reporting function for the provider network area, initiates database improvement efforts, and represents the provider network area on company IT projects. Develops and maintains standards for database integrity, coordinates corrective activities to clean database and retain users, and manages communication processes with other departments regarding database improvements. Designs report formats and produces reports for internal customers. Oversees data entry and trains new database users."]
[null,"2591","Manager, Benefit Plan Systems","Benefit Plan Database","Manages the implementation of system applications that administer managed care contract provisions and provider files. Oversees the assignment of rate coding and the verification of fee schedule loading."]
[null,"2592","Benefit Plan Systems Analyst","Benefit Plan Database","Selects, implements, and loads the system applications that administer managed care contract provisions. Assigns the rate coding to ensure the system takes the appropriate discounts, per diems, case costs, and fee schedule. Coordinates implementation and verification of the loading of the fee schedule. Examines fee schedules for proper coding. Prepares the system entry to adjudicate contract provisions. Creates and maintains networks and delivery systems in provider file system. Assists in training and development of procedures for provider loading processes. Requires experience in group claims and/or member provider services."]
[null,"2593","Benefit Plan Coding Compliance Specialist","Benefit Plan Database","Responsible for monitoring and auditing medical record coding performed by the Benefit Plan Systems Analyst to ensure proper CPT and ICD-9 coding requirements are met. Typically requires CPC or AAPC certification."]
[null,"2595","Provider Network Maintenance Specialist - Senior","Provider Network Database","Under general direction, maintains current provider data to ensure the quality of the network. Coordinates provider enrollment, and assists with coordination of meetings with providers for training, contracting, and reporting. Updates directories for all contracted organizations. Responsible for reporting and tracking provider calls and complaints. Typically requires three or more years of experience."]
[null,"2597","Provider Network Maintenance Specialist - Associate","Provider Network Database","Under direct supervision, maintains current provider data to ensure the quality of the network. Coordinates provider enrollment, and assists with coordination of meetings with providers for training, contracting, and reporting. Updates directories for all contracted organizations. Responsible for reporting and tracking provider calls and complaints. Typically requires less than three years of experience.","D"]
[null,"2600","Director, Compliance/Privacy","Compliance & Privacy","Directs efforts ensuring compliance with governmental requirements. Represents the organization in government compliance matters as well as regulatory meetings and activities. Develops and implements business plans. Serves as principal contact with government agencies. May be over privacy issues also. Typically has seven or more years of related experience and three to five years of management experience."]
[null,"2605","Manager, Compliance/Privacy","Compliance & Privacy","Responsible for ensuring compliance with governmental requirements. Develops and implements compliance policies and procedures. Researches compliance issues and recommends changes that assure compliance with contract obligations. Maintains relationships with government agencies. Coordinates site visits for regulators, coordinates implementation and compliance with corrective action plans, as needed. May be over privacy staff also. Responsible for hiring, training, and firing staff. Typically has six or more years of related experience with two to three years of supervisory experience."]
[null,"2610","Compliance/Privacy Specialist - Senior","Compliance & Privacy","Under general direction, implements compliance procedures and conducts complex audits from a legislative/regulatory standpoint. Investigates and resolves complex compliance issues. Communicates with regulators to resolve issues. May be over privacy procedures and audits also. May provide guidance or expertise to less experienced specialists. Typically requires three or more years of related experience."]
[null,"2615","Compliance/Privacy Specialist - Associate","Compliance & Privacy","Under direct supervision, conducts audits and provides support for other internal or external auditors. Investigates and resolves compliance issues from a legislative/regulatory standpoint. Communicates with regulators to resolve issues. May be over privacy procedures and audits also. Typically requires less than three years of related experience.","D"]
[null,"2620","HIPAA Compliance Coordinator","Compliance & Privacy","Monitors compliance in accordance with government regulations relating to the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Researches available resources and coordinates implementation of this highly specialized and technical information. Coordinates the implementation of HIPAA's transaction, privacy, and security standards. May also serve as a resource for HIPAA issues for affiliates. Typically reports to the Top Privacy Officer."]
[null,"2625","Clinical Policy Coding Coordinator","Medical Policy","Responsible for medical research and developing utilization management pre-certification criteria for medical policies to be used by review, utilization, and case management nurses. Codes changes into claims systems using national coding structure for processing accuracy and clinical appropriateness once medical policy has been established. Serves as a liaison to business units for correct coding of claims. Researches questions and issues from internal physicians and nurses as they relate to developed medical policies. Identifies and coordinates appropriate codes to support claim system edits that direct payment of medical services. Acts as a resource for clinical coding with knowledge of medical policy and clinical coding to identify the appropriate codes to represent services. Typically is a Certified Professional Coder (CPC)."]
[null,"2627","Medical Policy Coordinator (RN)","Medical Policy","Responsible for research, analysis, evaluation, and the development of medical policies following the medical policy, medical technology assessment and contract clarification policy development process. Develops and maintains policies through research via various mediums of current scientific medical evidence. Analyzes and evaluates documentation. Ensures consistency of research and development of medical policies utilizing the medical policy, technology assessment and contract clarification development process. Requires RN and three to five years of clinical experience."]
[null,"2650","Executive Chief of Staff","Executive Support","Directs, monitors, and contributes to special/strategic projects under the direction of a top executive. These projects are strategic in nature, highly complex, and involve creation and oversight of multifaceted teams. Advises, supports, assists, coordinates, and collaborates on special/strategic projects for a top executive. Organizes, problem solves, raises issues, and integrates initiatives, solutions, and actions. Acts as an executive liaison to resolve problems and ensure successful implementation of company initiatives. Requires a minimum of a Bachelor's degree with at least five years of managed care or health care experience."]
[null,"2653","Corporate Development & Strategy Director","Executive Support","Responsible for providing strategic, analytic, and project support. lead cross-functional teams through the process of building a business case and recommendation on key strategic decisions. These decisions fall generally in the areas of enterprise structure, scenario planning, and operational efficiency for mergers and acquisitions. Also responsible for providing strategic, analytic, and project support to other key business initiatives."]
[null,"2658","Medical Director of Behavioral Health","Medical Directors","Responsible for the oversight of the entire behavioral care management group. Develops procedures, processes, productivity targets, and new delivery models. Maintains efficient operations while ensuring attainment of quality of care and financial goals. Provides information for pricing guidelines based on utilization patterns and client demographics. Maintains productive relationships between clients and providers. Typically reports to the Top Behavioral Health Executive or Chief Medical Officer/Medical Director."]
[null,"2660","Medical Director - Specialty Business Unit","Medical Directors","Directs the medical policy for a specialty business unit. Establishes and implements policies and standards, evaluates new treatments, and conducts medical research to ensure the quality of the medical care provided to patients for a specialty business unit. May assist in sales presentations. Typically reports to Chief Medical Officer/Medical Director or Top Product/Service Line/Specialty Business Unit Executive."]
[null,"2663","Lead Medical Director","Medical Directors","Leads and supervises a group of medical directors as their administrative and clinical leader. Establishes and implements policies and standards to ensure the quality of the medical care provided to patients. Typically reports to Regional/Segment Medical Director or Chief Medical Officer."]
[null,"2665","Senior Medical Director","Medical Directors","Directs the medical policy. Establishes and implements policies and standards, evaluates new treatments, and conducts medical research to ensure the quality of the medical care provided to patients. Typically reports to Regional/Segment Medical Director."]
[null,"2670","Associate Medical Director","Medical Directors","Assists the senior medical director with medical policy. Establishes and implements policies and standards, evaluates new treatments, and conducts medical research to ensure the quality of the medical care provided to patients. Typically reports to the Regional/Segment Medical Director or Senior Medical Director."]
[null,"2690","Director, STARS Program","Medicare/Medicaid","Responsible for the development, implementation and management oversight of the company's Medicare Stars Program. Directs all Stars quality improvement programs and initiatives."]
[null,"2695","Director, HEDIS Program","Medicare/Medicaid","Responsible for the development, execution, strategy and oversight of key projects and initiatives across the Medicare, Medicaid and Commercial segments related to HEDIS. Oversees regulatory audit activities for HEDIS and ensure compliance and timely submission of the annual HEDIS project."]
[null,"2700","Director, Medicare Programs","Medicare/Medicaid","Directs staff activities and resources to accomplish goals and objectives that contribute to profitability of the Medicare business segment. Develops infrastructure, standards, and policies and procedures for the Medicare Program and participates in the strategic development of its products and services. Serves as principal contact with community leaders, providers, and regulatory agencies relative to Medicare products and services. Typically has seven or more years of related experience and three to five years of management experience."]
[null,"2705","Manager, Medicare Programs","Medicare/Medicaid","Provides support to assigned health plan and/or specialty companies relative to Medicare product implementation, operations, contract compliance, and federal contract application submissions. Serves as the primary resource on Medicare regulations for all assigned health plans. Ensures that assigned health plans are meeting or exceeding corporate Medicare performance benchmarks. Maintains relationships with Medicare regulators within a region. Responsible for hiring, training, and firing staff. Typically has six or more years of related experience."]
[null,"2730","Manager, Medicare Operations","Medicare/Medicaid","Leads and facilitates the management of the benefits, operations, communication, reporting, and data exchange of the Medicare product in support of strategic and corporate business objectives. Also responsible for operational compliance and adherence to federal regulations. Works collaboratively with business and operational units to ensure the Medicare operations are supported by effective, accurate and efficient business processes; benefits are accurately defined, communicated and configured; all member communications are compliant and data exchanges and reports are accurate, timely and meet federal requirements."]
[null,"2740","Director, Medicaid Programs","Medicare/Medicaid","Directs staff activities and resources to accomplish goals and objectives that contribute to profitability of the Medicaid business segment. Develops infrastructure, standards, and policies and procedures for the Medicaid Program and participates in the strategic development of its products and services. Serves as principal contact with community leaders, providers, and regulatory agencies relative to Medicaid products and services. Typically has seven or more years of related experience and three to five years of management experience."]
[null,"2745","Manager, Medicaid Programs","Medicare/Medicaid","Provides support to assigned health plan and/or specialty companies relative to Medicaid product implementation, operations, contract compliance, and federal contract application submissions. Serves as the primary resource on Medicaid regulations for all assigned health plans. Ensures that assigned health plans are meeting or exceeding corporate Medicaid performance benchmarks. Maintains relationships with Medicaid regulators within a region. Responsible for hiring, training, and firing staff. Typically has six or more years of related experience."]
[null,"2750","Manager, Medicaid Operations","Medicare/Medicaid","Leads and facilitates the management of the benefits, operations, communication, reporting, and data exchange of the Medicare product in support of strategic and corporate business objectives. Also responsible for operational compliance and adherence to federal regulations. Works collaboratively with business and operational units to ensure the Medicare operations are supported by effective, accurate and efficient business processes; benefits are accurately defined, communicated and configured; all member communications are compliant and data exchanges and reports are accurate, timely and meet federal requirements."]
[null,"2760","Director, Vendor Relations/Oversight","Vendor Relations","Responsible for oversight of all contracts which support the operational functions areas (e.g., Claims, Member Service, Enrollment). Responsible for all deliverables associated with statements of work (SOW), business agreements, service/maintenance agreements and/or contracts which directly impact the function areas described above. Responsible for the maintaining regular contact with vendors, developing plans for all vendor activities, controlling supplier governance packages, managing cost and risk analysis, and measuring performance metrics for various vendors. Typically requires a Bachelor's degree and has seven or more years of related experience with three to five years of management experience.","N"]
[null,"2765","Manager, Vendor Relations/Oversight","Vendor Relations","Manages the daily operations of the vendor relations department by reviewing all contracts which support the operational functions areas (e.g., Claims, Member Service, Enrollment). Responsible for all deliverables associated with statements of work (SOW), business agreements, service/maintenance agreements and/or contracts which directly impact the function areas described above. Maintains regular contact with vendors, develops plans for all vendor activities, controls supplier governance packages, manages cost and risk analysis, and measures performance metrics for various vendors. Responsible for the hiring, training, and firing of staff. Typically has six or more years of related experience.","N"]
[null,"2768","Vendor Relations/Oversight Analyst - Senior","Vendor Relations","Under general direction, maintains regular contact with vendors, develops plans for all vendor activities, controls supplier governance packages, manages cost and risk analysis, and measures performance metrics for various vendors. Typically requires five or more years of related experience.","N"]
[null,"2770","Vendor Relations/Oversight Analyst - Intermediate","Vendor Relations","Under general supervision, maintains regular contact with vendors, develops plans for all vendor activities, controls supplier governance packages, manages cost and risk analysis, and measures performance metrics for various vendors. Typically requires three or more years of related experience.","N"]
[null,"2800","Manager, Nurse Call Center","Nurse Call Center Services","Develops and implements strategic plans and procedures for the nurse call center operation. Ensures process efficiency and quality service. Requires a RN and typically has call center nurse experience with two years of supervisory experience."]
[null,"2805","Supervisor, Nurse Call Center","Nurse Call Center Services","Provides leadership, guidance, and support focusing on quality services and compliance with company standards for the call center. Requires a RN and typically has two to three years of call center nurse experience."]
[null,"2815","Call Center Nurse (RN)","Nurse Call Center Services","Performs telephone triage to assess member's needs and provide relevant health information to assist member in making health care decisions. Performs thorough symptom assessment of caller's situation using established criteria and protocol. Utilizes established software, written materials, on-line resources and nursing background to provide callers with appropriate medical information. Refers more complex issues for consultation. Requires a RN with typically three years of clinical nursing experience."]
[null,"2830","Director/Manager, Employee Assistance Program (EAP)","EAP Services","Directs and manages the overall operations of the EAP (Employee Assistance Program) group. Plans, develops, and implements EAP products and services. Develops and oversees group budget. Typically requires a Master's degree level mental health professional or a registered psychiatric nurse with two years of EAP experience. Responsible for hiring, training, and firing staff.","B"]
[null,"2845","Employee Assistance Program (EAP) Counselor","EAP Services","Provides telephone crisis intervention, assessment, short-term problem resolution, referral, and case management. Addresses a wide range of issues including problems in daily living, psychiatric crisis, and violent situations. Requires expertise and specialized knowledge in substance abuse, domestic abuse, grief counseling, workplace problems, and management consultation. Typically requires a Master's degree in counseling, psychology, social work, or related field with two years post-Master's degree experience in counseling."]
[null,"2850","Director, Pharmacy","Pharmacy Services","Develops and directs the pharmacy program with emphasis on disease state management and outcomes. Develops and maintains a managed care network of pharmacies. Responsible for development of reimbursement methodologies, providing effective on-site audits of participating pharmacies, and for providing effective resolution to service inquiries. Typically is a Registered Pharmacist and has seven or more years of related experience and three to five years of management experience. Typically reports to the Top Pharmacy Executive."]
[null,"2852","Director, Mail-Order Pharmacy Center","Pharmacy Services","Responsible for operations of the mail-order pharmacy center. Develops and maintains strategies to fulfill prescriptions, comply with regulatory and reporting standards, provide quality member service, and collect drug utilization data. Typically reports to the Top Pharmacy Executive or Top Pharmacy Benefits Management (PBM) Executive."]
[null,"2853","Manager, Pharmacy","Pharmacy Services","Responsible for the daily activities of pharmacists and could also manage pharmacy technicians in the organization's pharmacy program. Assists in the development and maintenance of a managed care network of pharmacies. May also be responsible for assisting in the development of reimbursement methodologies, providing effective on-site audits of participating pharmacies, and for providing effective resolution to service inquiries. Typically is a Registered Pharmacist and has six or more years of related experience."]
[null,"2856","Supervisor, Pharmacy","Pharmacy Services","Responsible for the daily activities of the pharmacy department that work in a managed care setting. Typically is a Certified Pharmacy Technician (CPhT) and has six or more years of related experience.","B"]
[null,"2857","Pharmacy Technician","Pharmacy Services","Provides efficient and accurate responses to external customers (physicians, office staff, pharmacy providers, members, and brokers), and internal team members. Resolves outpatient pharmacy benefit coverage and prescription claim problems. Communicates drug formulary guidelines, including drug formulary alternatives, prior authorization criteria, and group/member eligibility problems. Requires a Certified Pharmacy Technician (CPhT)."]
[null,"2863","BCBS Interplan Analyst - Senior","BlueCross BlueShield Interplan","Under general direction, communicates with out-of-state providers, members, and other BlueCross BlueShield plans regarding all plan benefits and claims processing. May also develop procedures, systems, and presentations regarding inter-BCBS plans programs. Keeps abreast of trends, events, and changes in government legislation and regulation impacting the BCBS plans. Typically requires BS/BA degree and five to seven years of related experience.","N"]
[null,"2865","BCBS Interplan Analyst - Associate","BlueCross BlueShield Interplan","Under direct supervision, communicates with out-of-state providers, members, and other BlueCross BlueShield plans regarding all plan benefits and claims processing. Typically requires a Bachelor's degree in a related area with less than three years of experience in health care or managed care.","B"]
[null,"2870","Program Manager - Senior","Program Management","Under general direction, responsible for managing multiple continuous and/or multi-year programs spanning multiple years that impact one or more business units or one larger project. Within formal project management methodologies, plans project timeline and milestones, tracks progress, monitors and communicates project status regularly, and identifies and resolves issues related to project. Typically has project management certification. Typically requires BS/BA degree and five to seven years of related experience. Frequently has a MBA."]
[null,"2872","Program Manager - Associate","Program Management","Under direct supervision, responsible for managing continuous and/or a multi-year program spanning multiple years and typically confined to a single business unit and/or function. Within formal project management methodologies, plans project timeline and milestones, tracks progress, monitors and communicates project status regularly, and identifies and resolves issues related to project. Typically has project management certification. Typically requires BS/BA degree and three to five years of related experience.","D"]
[null,"2873","Project Management - Director","Project Management","Directs and oversees effective management of multiple projects. Coordinates optimum allocation of financial and other organizational resources to project teams, supervising project managers. Requires project management certification. Typically requires BS/BA degree and eight or more years of related experience. Frequently has a MBA."]
[null,"2875","Project Manager - Senior","Project Management","Under general direction, responsible for managing multiple projects typically spanning at least one year that impact one or more business units or one larger project with a start and end date. Within formal project management methodologies, plans project timeline and milestones, tracks progress, monitors and communicates project status regularly, and identifies and resolves issues related to project. Typically has project management certification. Typically requires BS/BA degree and five to seven years of related experience, part of which should involve project management on a smaller scale. Frequently has a MBA."]
[null,"2880","Project Manager - Associate","Project Management","Under direct supervision, responsible for managing projects that are on a limited timeframe and are typically confined to a single business unit and/or function with a start and end date. Within formal project management methodologies, plans project timeline and milestones, tracks progress, monitors and communicates project status regularly, and identifies and resolves issues related to project. Typically has project management certification. Typically requires BS/BA degree and three to five years of related experience.","D"]
[null,"2885","Provider Network Connectivity (EDI) Manager","Provider Network Connectivity (EDI)","Responsible for the daily operations of the department providing analysis and support to both internal and external customers regarding EDI-related issues (i.e., electronic exchange of data including enrollment, claims, payments, and clearinghouse activities). Researches, evaluates, and implements vendor partner initiatives and manages end-to-end implementation process (e.g., provider evaluation/coordination, vendor evaluation/coordination, completion of banking and contractual agreements, provider setup, testing, and activation.) Typically requires five or more years of experience in EDI."]
[null,"2890","Provider Network Connectivity (EDI) Analyst - Senior","Provider Network Connectivity (EDI)","Under general direction, provides analysis and support to both internal and external customers on complex EDI-related issues (i.e., electronic exchange of data including enrollment, claims, payments, and clearinghouse activities). Responds to complex inquiries relating to EDI from providers and internal departments. May provide guidance or expertise to less experienced analysts. May help customers with modem set-up, connection protocols, etc. Typically requires three or more years of claims processing experience and/or technical helpdesk support experience and one to two years of experience in EDI."]
[null,"2895","Provider Network Connectivity (EDI) Analyst - Associate","Provider Network Connectivity (EDI)","Under direct supervision, provides analysis and support to both internal and external customers on EDI-related issues (i.e., electronic exchange of data including enrollment, claims, payments, and clearinghouse activities). Responds to inquiries relating to EDI from providers and internal departments. Typically requires less than three years of claims processing experience and/or technical helpdesk support experience.","D"]
[null,"2903","Pharmacy Benefit Quality Specialist","Pharmacy Services","Ensures that pharmacy programming has been set-up accurately by the PBM. Provides quality assurance and testing related to claim adjudication and plan set-up. Ensures all coding has been done appropriately and reviews system generated outputs to validate outcomes. Provides oversight of all PBM data interfaces, by ensuring control points are in place to confirm delivery and receipt of files, accuracy for those files and that mapping of data fields is correct."]
[null,"2905","Pharmacy Utilization Management Specialist","Pharmacy Services","Responsible for the daily, weekly, and monthly/periodic administrative functions necessary to update and maintain the utilization management programs. Works with the Clinical Pharmacist - Utilization Management and PBM to make updates to utilization management criteria sets, identify affected members and providers, analyze decisions and develop reports for leadership to demonstrate the effectiveness of the program."]
[null,"2906","Clinical Pharmacist - Senior","Pharmacy Services","Performs highly complex research and analysis related to prescription drugs and their applications in support of formulary development and the prior authorization program. Researches new prescription drugs or new applications of existing drugs and develops prescription drug use guidelines. Administers prior authorization program, assisting Medical Director in case review. Participates in physician education and outreach program. Performs claims analysis for drug utilization review, fraud, abuse, and over utilization. Gathers clinical and financial information for presentation to the Medical Director for prior authorization case review. Requires a pharmacy degree with typically five or more years of clinical experience."]
[null,"2907","Clinical Pharmacist - Intermediate","Pharmacy Services","Performs highly complex research and analysis related to prescription drugs and their applications in support of formulary development and the prior authorization program. Researches new prescription drugs or new applications of existing drugs and develops prescription drug use guidelines. Administers prior authorization program, assisting Medical Director in case review. Participates in physician education and outreach program. Performs claims analysis for drug utilization review, fraud, abuse, and over utilization. Gathers clinical and financial information for presentation to the Medical Director for prior authorization case review. Requires a pharmacy degree with typically three to five years of clinical experience."]
[null,"2908","Clinical Pharmacist - Associate","Pharmacy Services","Performs highly complex research and analysis related to prescription drugs and their applications in support of formulary development and the prior authorization program. Researches new prescription drugs or new applications of existing drugs and develops prescription drug use guidelines. Administers prior authorization program, assisting Medical Director in case review. Participates in physician education and outreach program. Performs claims analysis for drug utilization review, fraud, abuse, and over utilization. Gathers clinical and financial information for presentation to the Medical Director for prior authorization case review. Requires a pharmacy degree with typically less than three years of clinical experience."]
[null,"2910","Manager, Disability/Workers' Compensation Claims","Disability and Workers' Compensation","Responsible for the daily activities of the disability/workers' compensation function. Assists in establishing, coordinating, and implementing disability/workers' compensation claims policies and procedures. Directs unit quality review and corrective action plans. Typically has five to six years of experience in disability/workers' compensation claims with two years of management experience."]
[null,"2925","Disability/Workers' Compensation Claims Specialist","Disability and Workers' Compensation","Under general supervision, reviews, analyzes, investigates, makes liability decisions, and approves the release of benefit payments up to authorized levels on initial, continued, and reopened claims. Investigates questionable claims. Determines the need for additional medical information. Performs periodic follow-ups to verify continued existence of a disabling condition. Responds to inquiries from claimants, attorneys, physicians, and policy holders. Typically responsible for complex or specialty claims and has three to five years of experience processing and adjudicating claims."]
[null,"2940","Disability/Workers' Compensation Nurse Case Manager","Disability and Workers' Compensation","Facilitates quality cost effective care for injured/ill claimants via early assessment, intervention, and evaluation of claimant's medical status and health care requirements. Gathers information from claimant, family, medical providers, insured party, and claims staff throughout recovery and rehabilitation. Educates injured/ill claimant, insured party, and health care provider regarding claimant's response to treatment and progress. Evaluates components of the injured/ill claimant's job with claimant and employer. Clarifies critical job demands to suggest modifications/accommodations in compliance with government regulations. Requires clinical experience in applicable nursing specialty field and knowledge of medical case management or utilization review."]
[null,"2943","Director, Grievance & Appeals","Grievance and Appeals","Directs the grievance and appeal department. Responsible for the formal grievance process and ensures it is consistent with organizational policies and procedures which is compliant with state and federal guidelines. Typically has seven or more years of related experience in health care with three to five years of management experience."]
[null,"2945","Manager, Grievance & Appeals","Grievance and Appeals","Manages the formal grievance process to ensure the resolution of grievances and appeals consistent with organizational policies and procedures and which is compliant with state and federal guidelines. Prepares formal hearing briefs and/or appears at hearings as a representative of the organization. Oversees daily operations and case load assignments/priorities. Recruits, hires, trains, and coaches staff. Typically requires prior managerial experience and five or more years of managed care experience."]
[null,"2947","Supervisor, Grievance & Appeals","Grievance and Appeals","Supervises a unit which responds to grievances and appeals to ensure the resolutions are consistent with organizational policies and procedures and which are compliant with state and federal guidelines. Oversees daily operations and case load assignments/priorities. Provides expertise and guidance to grievance and appeals staff. Typically has three or more years of experience and reports to the Manager, Grievance & Appeals."]
[null,"2950","Grievance & Appeal Nurse","Grievance and Appeals","Responsible for the resolution of clinical complaints and appeals. Reviews documentation and interprets data obtained from clinical records to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and provider issues. Independently coordinates the clinical resolution with internal/external clinician support as required. Documents and summarizes to all parties involved in the case the investigation's results. Requires an RN with three to five years of managed care experience.","D"]
[null,"2953","Grievance & Appeals Specialist - Senior","Grievance and Appeals","Under general direction, receives, documents, investigates, refers, and coordinates grievances and appeals. Initiates case files for each grievance and ensures compliance with organizational and regulatory requirements. Typically requires five years billing, claims, customer service, or health insurance experience and familiarity with state and federal regulations.","N"]
[null,"2955","Grievance & Appeals Specialist - Associate","Grievance and Appeals","Under direct supervision, receives, documents, investigates, refers, and coordinates grievances and appeals. Initiates case files for each grievance and ensures compliance with organizational and regulatory requirements. Typically requires two to five years billing, claims, customer service, or health insurance experience and familiarity with state and federal regulations.","B"]
[null,"2958","Business Architect","Process Improvement","Responsible for defining the external and internal systems, employees, customers and suppliers that make up an organization, as well as how information is shared across these groups. Tracks economic, regulatory and market trends, evaluates their organization's health, and pinpoints opportunities for growth. Collects information from market analysts, external vendors, consultants, and the management team to help build a business architecture strategy around the company's products and services. Maps company objectives to metrics that measure the company's performance and efficiency. Typically has a MBA."]
[null,"2960","Business Consultant - Senior","Process Improvement","Responsible for designing conceptual models, contracting, initiative planning, business results, and ongoing client relationship management and satisfaction for high value initiatives and parts of larger initiatives that impact the delivery of products and services that support the organization's marketplace strategy. Responsible for providing guidance and direction to external vendors, external consultants, consulting team members, and/or other staff as required in support of initiatives. Accountable for transferring knowledge, best practices (external and internal), methodology, and tools to client organizations."]
[null,"2965","Business Consultant - Associate","Process Improvement","Responsible for initiative planning, ongoing client relationship management, and the satisfaction for assigned initiatives that impact the delivery of products and services that support the organization's marketplace strategy. Collaborates with external vendors, external consultants, consulting team members, and/or other staff as required in support of initiatives. Accountable for transferring knowledge, best practices (external and internal), methodology, and tools to client organizations."]
[null,"2974","Manager, Reporting (non-IT)","Reporting","Responsible for the department that collects, validates, analyzes, and organizes data into meaningful reports for management decision making as well as designing, developing, testing, and deploying reports to provider networks and other end users for operational and strategic analysis. Typically holds a Bachelor's degree and has six or more years of experience with two to three years of supervisory experience."]
[null,"2975","Reporting Analyst (non-IT) - Senior","Reporting","Under general direction, collects, validates, analyzes, and organizes data into meaningful reports for management decision making as well as designing, developing, testing and deploying reports to provider networks and other end users for operational and strategic analysis. Typically requires three or more years of related experience."]
[null,"2976","Reporting Analyst (non-IT) - Associate","Reporting","Under general supervision, collects, validates, analyzes, and organizes data into meaningful reports for management decision making. Also designs, develops, tests, and deploys reports to provider networks and other end users for operational and strategic analysis. Typically requires less than three years of related experience."]
[null,"2980","Business Analyst - Senior","Business Analysis","Under general direction, performs various analysis and interpretation to link business needs and objectives for assigned function. Supports business initiatives through data analysis, identification of implementation barriers and user acceptance testing of various systems. Identifies and analyzes user requirements, procedures, and problems to improve existing processes. Coordinates with various business units and departments in the development and delivery of training programs. Typically has a bachelor's degree with experience in the healthcare industry, preferably with managed care techniques and administrative philosophy and has five or more years of related experience."]
[null,"2985","Business Analyst - Intermediate","Business Analysis","Under general supervision, performs various analysis and interpretation to link business needs and objectives for assigned function. Supports business initiatives through data analysis, identification of implementation barriers and user acceptance testing of various systems. Identifies and analyzes user requirements, procedures, and problems to improve existing processes. Coordinates with various business units and departments in the development and delivery of training programs. Typically has a bachelor's degree with experience in the healthcare industry, preferably with managed care techniques and administrative philosophy and has three to five years of related experience."]
[null,"2990","Business Analyst - Associate","Business Analysis","Under direct supervision, performs various analysis and interpretation to link business needs and objectives for assigned function. Supports business initiatives through data analysis, identification of implementation barriers and user acceptance testing of various systems. Identifies and analyzes user requirements, procedures, and problems to improve existing processes. Coordinates with various business units and departments in the development and delivery of training programs. Typically has a bachelor's degree with experience in the healthcare industry, preferably with managed care techniques and administrative philosophy and has less than three years of related experience."]
[null,"3000","Senior Director, Sales","Sales - Commercial Health Plans","Responsible for the overall sale of new business, new business to existing accounts, and account retention for a plan or specified geographic area. Manages client assignments, hires and trains sales staff, and manages close ratios. Develops and implements strategies and policies relating to new and renewal commercial sales and service. Typically requires eight or more years of experience, including four or more years of management experience. NOTE: This is a second level management role consisting of multiple incumbents, which may not exist in some organizations/locations."]
[null,"3003","Director, Sales","Sales - Commercial Health Plans","Directs all prospect and sales activities for commercial products for a plan or specified geographic area. Responsible for the development and implementation of strategies and policies relating to new and renewal commercial sales and service. Typically requires seven or more years of experience with three or more years of management experience."]
[null,"3005","Manager, Sales","Sales - Commercial Health Plans","Responsible for attaining sales objectives for a plan or specified geographic area. Develops and implements sales strategies to achieve membership growth. Responsible for the management of the sales force. Typically reports to Director, Sales. Typically requires six or more years of experience."]
[null,"3007","New Sales Representative - Senior","Sales - Commercial Health Plans","Under general direction, develops and implements sales strategies for targeted key accounts in a plan, a territory, or a specified geographic area. Very knowledgeable of complete line of products and services and clients' issues and needs. Responsible for seeking out new clients. Typically has five or more years of related sales experience."]
[null,"3008","New Sales Representative - Associate","Sales - Commercial Health Plans","Under direct supervision, develops and implements sales strategies for a group of accounts in a plan, a territory, or a specified geographic area. Knowledgeable of complete line of products and services and clients' issues and needs. Responsible for seeking out new clients. Typically has less than five years of related sales experience.","D"]
[null,"3010","Sales Representative and Account Manager - Senior","Sales - Commercial Health Plans","Under general direction, develops and implements sales strategies for targeted key accounts in a plan, a territory, or a specified geographic area. Very knowledgeable of complete line of products and services and clients' issues and needs. Focuses on seeking out new clients, maintaining productive working relationships, and expanding sales with existing clients. Typically has five or more years of related sales experience."]
[null,"3015","Sales Representative and Account Manager - Associate","Sales - Commercial Health Plans","Under direct supervision, develops and implements sales strategies for a group of accounts in a plan, a territory, or a specified geographic area. Knowledgeable of complete line of products and services and clients' issues and needs. Focuses on seeking out new clients, maintaining productive working relationships, and expanding sales with existing clients. Typically has less than five years of related sales experience.","D"]
[null,"3016","Manager, Inside Sales/Telemarketing","Inside Sales/Telemarketing","Responsible for the inside sales/telemarketing unit of the organization. Oversees policies, procedures, and operating structure of the unit. Establishes and implements product/service standards. Typically requires three or more years of experience."]
[null,"3017","Supervisor, Inside Sales/Telemarketing","Inside Sales/Telemarketing","Responsible for the daily operations of a team of representatives that respond to inbound calls inquiring about commercial health plans, place outbound calls based on leads, and complete the sale of products and/or services. Plans, directs, supervises, and evaluates work flow. Monitors performance of staff members, makes hiring decisions, and conducts performance appraisals. May approve special price concessions, quotes, bid allowances, or adjustments. Typically requires three or more years of experience."]
[null,"3018","Inside Sales/Telemarketing Representative - Senior","Inside Sales/Telemarketing","Under general direction, responds to inbound calls inquiring about commercial health plans, places outbound calls based on leads, and completes the sales of products and/or services. If not closed, arranges for field representative to visit prospect. Typically requires five or more years of telemarketing experience."]
[null,"3019","Director, Medicare Sales","Sales - Medicare/Medicaid Programs","Directs all prospect and sales activities for Medicare products for a specified geographic area. Responsible for the development and implementation of strategies and policies relating to Medicare sales and service. Typically requires seven or more years of experience with three to five years of management experience."]
[null,"3020","Manager, Medicare Sales","Sales - Medicare/Medicaid Programs","Responsible for attaining Medicare sales objectives for a plan or a specified geographic area. Develops and implements sales strategies for Medicare products and services. Responsible for the management of the Medicare sales staff. Typically requires six or more years of experience with two to three years of supervisory experience."]
[null,"3021","Inside Sales/Telemarketing Representative - Associate","Inside Sales/Telemarketing","Under general supervision, responds to inbound calls inquiring about commercial health plans, places outbound calls based on leads, and completes the sales of products and/or services. If not closed, arranges for field representative to visit prospect. Typically has less than five years of telemarketing experience."]
[null,"3025","Supervisor, Medicare Field Sales","Sales - Medicare/Medicaid Programs","Responsible for the supervision of Medicare field sales staff in a specified geographic area. Assists in developing and implementing sales strategies for Medicare products and services. Provides expertise and assistance to Medicare field sales staff. Requires five or more years of experience in sales."]
[null,"3030","Medicare Field Sales Representative","Sales - Medicare/Medicaid Programs","Responsible for selling Medicare products and services. May make sales presentations to potential qualified Medicare participants at their homes, doctors' offices, etc. using approved governmental guidelines. May initiate sales opportunities with seniors--individually or in groups--to sell individual Medicare supplemental policies. Makes on-site presentations to prospective seniors or senior groups to increase enrollment. Qualifies prospects on site and closes sale if possible, otherwise, refers to inside sales for follow-up. Typically requires one to two years of sales experience."]
[null,"3035","Medicare Account Manager","Sales - Medicare/Medicaid Programs","Under general direction, manages the relationship with existing Medicare accounts. Responsible for reviewing Medicare accounts, selling new business to existing Medicare accounts, and converting Medicare accounts to a higher level of managed care. May also be responsible for new Medicare account installation. Typically has two or more years of related experience."]
[null,"3038","Medicare Inside Sales/Telemarketing Representative","Inside Sales/Telemarketing","Responsible for selling activities related to inbound calls inquiring about Medicare products. Qualifies prospects and attempts to close sale. If not closed, arranges for field representative to visit prospect. May originate calls from leads. Typically requires prior telemarketing experience."]
[null,"3050","Director, Sales - Individual Health Policies","Sales - Individual Health Policies","Directs all prospect and sales activities for individual health plan policies for a specified geographic area. Responsible for the development and implementation of strategies and policies relating to the sales and service of individual health plans. Typically requires seven or more years of related experience with three to five years of management experience."]
[null,"3055","Manager, Sales - Retail/Individual Health Policies","Sales - Individual Health Policies","Responsible for the individual health policy sales staff in a specified geographic area or a retail location. Assists in the development and implementation of sales strategies for individual health plan products and services. Provides expertise and assistance to sales staff. Typically requires five or more years of related experience.","B"]
[null,"3060","New Sales Representative - Individual Health Policies","Sales - Individual Health Policies","Primary responsibility includes prospecting and generating new health plan policy sales to individuals."]
[null,"3062","Retail New Sales Representative","Sales - Individual Health Policies","Primary responsibility includes prospecting and generating new health plan policy sales to individuals at a retail location."]
[null,"3100","Director, Sales Support","Sales Support","Directs sales support services and operations. Supports the development and implementation of customized products and product enhancements. Responsible for developing, planning, and carrying out departmental projects, goals, and budgets. Typically requires seven or more years of experience with three to five years of management experience."]
[null,"3105","Manager, Sales Support","Sales Support","Responsible for the daily operations of sales support services. Interacts with underwriting in coordinating rate quotes, with brokers to help manage flow of proposal packages and quotes, and with employer groups in resolving daily service issues. May also assist with RFPs and participate in open enrollment meetings. Responsible for hiring, training, and firing staff. Typically has six or more years of experience with two to three years of supervisory experience. Normally reports to the Director, Sales Support."]
[null,"3110","Supervisor, Sales Support","Sales Support","Responsible for the daily operations of sales support services. Interacts with underwriting in coordinating rate quotes, with brokers to help manage flow of proposal packages and quotes, and with employer groups in resolving daily service issues. May also assist with RFPs and participate in open enrollment meetings. Typically requires five or more years of experience. Normally reports to the Manager, Sales Support."]
[null,"3115","Sales Support Specialist","Sales Support","Responsible for case-specific sales support processes. Interacts with underwriting in coordinating rate quotes, with brokers to help manage flow of proposal packages and quotes, and with employer groups in resolving daily service issues."]
[null,"3125","Director, Sales Incentive Administration","Sales Incentive Administration","Responsible for the sales incentive administration process, which includes distributing incentive payments, communicating incentive plans and payment details. Typically holds a Bachelor's degree with seven or more years of experience with three to five years of management experience."]
[null,"3130","Manager/Supervisor, Sales Incentive Administration","Sales Incentive Administration","Responsible for the daily operations of the sales incentive administration process. Resolves any pay or service issues. Responsible for hiring, training, and firing staff. Typically requires five or more years of experience."]
[null,"3135","Sales Incentive Administration Specialist","Sales Incentive Administration","Responsible for calculating and paying sales commissions. Interacts with sales employees to resolve any issues or explain sales payment details."]
[null,"3150","Manager, Broker Relations","Broker Relationships","Responsible for managing and maintaining strategic relationships with health benefits consultants and brokers external to the organization. Develops and implements marketing plans and troubleshoots operations issues and may lead broker training seminars. Typically requires a Bachelor's degree and at least 3 years of health care and sales experience."]
[null,"3155","Broker Relations Representative","Broker Relationships","Under general direction, assists in maintaining and promoting a favorable business relationship with the brokerage community. Ensures broker commissions are paid accurately and timely. Addresses and handles concerns, issues and questions from brokers and customers. Typically has more than 3 years experience in health insurance sales."]
[null,"3200","Senior Director, Account Management","Account Management","Directs the strategic planning for client renewal and retention strategies for the account management function for a plan or specified geographic area. Develops and executes account strategies that result in revenue growth. Works with internal and external business partners to ensure that account expectations are met. Provides leadership and direction to the account management function and its staff. Typically requires eight or more years of experience with four or more years of management experience. NOTE: This is a second level management role consisting of multiple incumbents, which may not exist in some organizations/locations."]
[null,"3203","Director, Account Management","Account Management","Responsible for client retention and possible new business sales to existing accounts for a plan or specified geographic area. Manages client assignments and recruits and coaches team. Develops and implements strategies and policies relating to account management. Typically requires seven or more years of experience with three or more years of management experience."]
[null,"3205","Manager, Account Management","Account Management","Responsible for growing membership within existing accounts and for directly managing business relationships with client accounts. Manages the account managers and the administrative staff. Ensures that systems and processes are in place to meet the needs of internal and external clients. Typically requires six or more years of experience."]
[null,"3210","Account Manager - Senior","Account Management","Under general direction, manages the relationship with the larger and/or complex accounts. Responsible for managing a book of business for existing accounts. Responsible for reviewing accounts, selling new business to existing accounts, and converting accounts to a higher level of managed care. May provide guidance or expertise to less experienced account managers. May also be responsible for new account installation. Typically has five or more years of related experience."]
[null,"3215","Account Manager - Associate","Account Management","Under direct supervision, manages the relationship with existing accounts. Responsible for managing a book of business for existing accounts. Responsible for reviewing accounts, selling new business to existing accounts, and converting accounts to a higher level of managed care. May also be responsible for new account installation. Typically has less than five years of related experience.","D"]
[null,"3218","Sales Assistant","Account Services","Provides timely and effective administrative support. Processes sales and invoices so that customer orders are dispatched, invoiced, and paid accurately and on time. Drafts sales documentation, proposals, reports, and correspondence such as sales contracts and maintenance agreements. Makes standard calculations to accurately compile and report statistics. Performs background research on customer accounts, prospects, competitors, and industry trends to support the sales teams activities. Answers internal and customer inquires. Communicates with staff from other areas in the organization to confirm the status of orders and resolve customer complaints. Maintains up-to-date customer records."]
[null,"3219","Manager, Account Services","Account Services","Responsible for the daily operations of the account service group which respond to inquiries, solve problems, and ensure client satisfaction. Supports account managers. Responsible for hiring, training, and firing staff. Typically requires five or more years of experience."]
[null,"3220","Account Service Representative - Inside","Account Services","Responsible for responding to inquiries, solving problems, and ensuring client satisfaction with products and service. Coordinates with the account benefits manager to ensure needs are met and potential problems are averted. Keeps account manager informed of account status and opportunities for expanded business."]
[null,"3223","Account Service Representative - Outside","Account Services","Responsible for the on-going service and maintenance of new and existing accounts. Conducts on-site presentations to existing and prospective clients to educate, inform, and gather feedback. Keeps account manager informed of account status and opportunities for expanded business."]
[null,"3225","Director, Account Management - National Accounts","Sales/Account Management - National Accounts","Directs and oversees a number of national account manager positions. Responsibilities include implementing sales strategies to achieve revenue targets through selling new business to existing accounts, managing major account relationships, and organizing and developing the national accounts sales force. Typically requires seven or more years of experience with three to five years of management experience."]
[null,"3230","Account Manager - National Accounts - Senior","Sales/Account Management - National Accounts","Under general direction, primary responsibility includes strategic account management for large and/or complex national accounts. Also, responsible for the sales of additional products and services to existing accounts. In some organizations, this position may also be responsible for generating or assisting in new sales for national accounts. Typically has five or more years of related experience."]
[null,"3235","Account Manager - National Accounts - Associate","Sales/Account Management - National Accounts","Under direct supervision, primary responsibility includes strategic account management for national accounts. Also responsible for the sales of additional products and services to existing accounts. In some organizations, this position may also be responsible for generating or assisting in new sales for national accounts. Typically has less than five years of related experience.","D"]
[null,"3238","Director, Sales - National Accounts","Sales/Account Management - National Accounts","Directs all prospect and sales activities for national business. Responsible for the development and implementation of strategies and policies relating to new and renewal national business sales and service. Typically requires seven or more years of experience with three or more years of management experience."]
[null,"3240","New Sales Representative - National Accounts","Sales/Account Management - National Accounts","Under general direction, primary responsibilities includes prospecting and generating new sales for national accounts. May be responsible for more complex accounts. Typically has more than five years of sales experience.","T"]
[null,"3280","Account Manager - Specialty Programs","Sales/Account Management - Specialty Programs","Manages the relationship with existing accounts for specialty programs such as dental, vision, behavioral health, pharmacy or EAP. Responsible for managing a book of business for existing accounts. Responsible for reviewing accounts, selling new business to existing accounts, and converting accounts to a higher level of managed care. May also be responsible for new account installation."]
[null,"3290","New Sales Representative - Specialty Programs","Sales/Account Management - Specialty Programs","Primary responsibility includes prospecting and generating new sales for specialty programs such as dental, vision, behavioral health, pharmacy or EAP (Employee Assistance Program)."]
[null,"3293","Manager, FEP Sales/Account Management","Federal Employee Program (FEP)","Responsible for managing and planning, the FEP (Federal Employee Health Benefits Program) team to accomplish the sales and servicing objectives of the program. May be responsible for implementing sales, marketing and servicing strategy for sale and retention of FEP products. Hires, trains, coaches, counsels, and evaluates performance of direct reports. Monitors and ensures achievement of sale production goals and deliverables for market areas. Typically requires a Bachelor's degree and five or more years of experience."]
[null,"3295","FEP Field Service Sales/Account Manager - Senior","Federal Employee Program (FEP)","Under general direction, responsible for facilitating sales, enrollment, retention and territory management and servicing of the FEP business. Manages assigned accounts related to sale, enrollment and other consultative services. Conducts open enrollment presentations and manages the open enrollment process. Provides information to current and potential enrollees to highlight and explain benefit enhancements and/or changes. Typically requires a bachelor's or an associate degree in Sales/Marketing and a Health and Life license and over three years of experience."]
[null,"3297","FEP Field Service Sales/Account Manager - Associate","Federal Employee Program (FEP)","Under direct supervision, responsible for facilitating sales, enrollment, retention and territory management and servicing of the FEP business. Manages assigned accounts related to sale, enrollment and other consultative services. Conducts open enrollment presentations and manages the open enrollment process. Provides information to current and potential enrollees to highlight and explain benefit enhancements and/or changes. Typically requires a bachelor's or an associate degree in Sales/Marketing and a Health and Life license and less three years of experience.","D"]
[null,"3300","Director, Marketing","Marketing","Responsible for organizing and managing the marketing function. Develops, implements, and executes marketing strategies and plans to achieve annual and long-term goals. Typically holds a Bachelor's degree in a related area with seven or more years of experience."]
[null,"3305","Manager, Marketing","Marketing","Responsible for the daily operations of the marketing function. Assists in the development of marketing strategies. Responsible for hiring, training, and firing staff. Typically holds a Bachelor's degree in a related area with six or more years of experience."]
[null,"3310","Marketing Specialist - Senior","Marketing","Under general direction, responsible for preparing proposal presentation and marketing materials. Coordinates the distribution of internal and external marketing literature. May provide expertise and guidance to less experienced specialists. Typically has three or more years of experience."]
[null,"3315","Marketing Specialist - Associate","Marketing","Under direct supervision, assists in preparing proposal presentation and marketing materials. Coordinates the distribution of internal and external marketing literature. Typically has less than three years of experience.","D"]
[null,"3320","Director, Marketing Research","Marketing Research","Directs the marketing research functions for the organization. Develops, implements, and executes marketing research strategies and plans to achieve annual and long-term goals. Monitors competitors' activities and develops ways to differentiate the organization from competitors. Typically holds a Bachelor's degree in a related area with seven or more years of experience."]
[null,"3325","Manager, Marketing Research","Marketing Research","Designs and manages marketing research projects. Monitors and analyzes competitors and potential competitors. May assist in developing and implementing marketing research strategies. Responsible for hiring, training, and firing staff. Typically holds a Bachelor's degree in a related area with six or more years of experience."]
[null,"3330","Marketing Research Specialist - Senior","Marketing Research","Under general direction, responsible for research and competitive analysis for marketing projects. Works with other functional areas to collect information. Analyzes and interprets data and recommends changes to marketing program. May provide expertise and guidance to less experienced specialists. Typically has three or more years of experience."]
[null,"3335","Marketing Research Specialist - Associate","Marketing Research","Under direct supervision, assists with research and competitive analysis for marketing projects. Works with other functional areas to collect information. Analyzes and interprets data and assists in making recommendations for changes to the marketing programs. Typically has less than three years of experience.","D"]
[null,"3337","Consumer / User Experience Manager","Marketing Research","Responsible for managing the consumer / user experience group and the developing communication and working protocols with internal departments that need this data."]
[null,"3340","Director, Advertising","Advertising","Develops and implements advertising strategies, which includes programs related to advertising and sales promotion. Manages advertising relationships. Advises management in developing the organization's business plans and strategies to attain sales and profit objectives through advertising. Typically holds a Bachelor's degree in a related area with seven or more years of experience."]
[null,"3345","Manager, Advertising","Advertising","Responsible for the daily operations of advertising and sales promotion projects/programs. Assists in the development of advertising strategies. Responsible for hiring, training, and firing staff. Typically holds a Bachelor's degree in a related area with six or more years of experience."]
[null,"3346","Manager, Social Media","Advertising","Responsible for all social media activities and promotion and advertising campaigns centered on the company's social presence. Typically approves the content on social networking websites, interactive marketing and related media. Participates in conversations that surround company content, products and brand to promote and maintain company reputation. Manages the social media team."]
[null,"3348","Social Media Specialist","Advertising","Coordinates social media activities and promotion/advertising campaigns centered on the company's social presence. Typically plans, creates, and/or produces content on social networking websites, interactive marketing and related media. Maintains social media sites and leads new social media strategic initiatives. May actively participate in a variety of Social Media sites and sources such as YouTube, Facebook, LinkedIn, Forums, Twitter, message boards and blogs on behalf of the company. Participates in conversations that surround company content, products and brand to promote and maintain company reputation. Typically requires a BA/BS degree."]
[null,"3350","Advertising Specialist","Advertising","Researches, writes, and edits advertising materials. Responsible for the printing and maintenance of new and current materials."]
[null,"3360","Director, Product Development/Management","Product Development","Directs the development of new products and the strategies used for implementation. Directs the formulation and implementation of business plans. Typically holds a Bachelor's degree in a related area with seven or more years of experience."]
[null,"3365","Manager, Product Development/Management","Product Development","Responsible for identifying and investigating emerging new product opportunities within a defined range of responsibility (e.g., health information reporting, retiree products, group health products). Manages staff in the design, development, and testing of select new products. Helps to formulate business plans to develop and implement products. Implements business plans and creatively solves product design, financial, marketing, or administrative problems. Typically holds a Bachelor's degree in a related area with six or more years of experience."]
[null,"3370","Product Manager - Senior","Product Development","Under general direction, responsible for the implementation, and maintenance of assigned products. Provides technical assistance to less experienced product managers. Typically has three or more years of experience."]
[null,"3375","Product Manager - Associate","Product Development","Under direct supervision, supports the implementation process of new products. Evaluates performance and feedback regarding products. Typically has less than three years of experience.","D"]
[null,"3377","Product Developer - Senior","Product Development","Under general direction, responsible for the design and development of assigned products. Responsible for product design and providing technical assistance to less experienced product developers. Typically has three or more years of experience."]
[null,"3378","Product Developer - Associate","Product Development","Under direct supervision, supports the design and development of new products. Evaluates performance and feedback regarding products. Typically has less than three years of experience.","D"]
[null,"3379","Consumer / User Experience Analyst","Marketing Research","Responsible for consumer / user experience analysis which includes reviewing customer/user verbatims, comparing results across product offerings, identifying key trends or outliers and reporting on progress. Using this analysis, communicates these results to and working with internal department teams to determine improvement programs as needed (i.e. departments include product development, client service, communications, online marketing, corporate marketing etc.). Understanding key buying triggers and customer needs."]
[null,"3380","Director, Marketing/Sales Communications","Marketing/Sales Communications","Responsible for organizing and managing the marketing/sales communication team. Develops, implements, and executes marketing/sales communications strategies and plans to achieve annual and long-term goals. Participates in sales strategy meetings and works closely with the sales, marketing, underwriting, and operations departments. Typically holds a Bachelor's degree with seven or more years of experience."]
[null,"3385","Manager, Marketing/Sales Communications","Marketing/Sales Communications","Responsible for the daily operations of the marketing/sales communications team. Assists in the development and implementation of marketing/sales communication strategies and overall product sales positioning which may include one or more of the following: executive summaries, proposal templates, facts sheets, cover letters, and public relations copy. Participates in sales strategy meetings and works closely with the sales, marketing, underwriting, and operations departments. Responsible for hiring, training, and firing staff. Typically holds a Bachelor's degree in a related area with six or more years of experience."]
[null,"3390","Marketing/Sales Communications Specialist - Senior","Marketing/Sales Communications","Under general direction, maintains and writes overall product sales positioning which may include one or more of the following: executive summaries, proposal templates, facts sheets, cover letters, and public relations copy. May participate in sales strategy meetings with the sales, underwriting, marketing, and operations departments. Provides expertise and guidance to less experienced writers. Typically has three or more years of experience."]
[null,"3395","Marketing/Sales Communications Specialist - Associate","Marketing/Sales Communications","Under direct supervision, may assist in maintaining and writing overall product sales positioning which may include one or more of the following: executive summaries, proposal templates, facts sheets, cover letters, and public relations copy. May participate in sales strategy meetings with the sales, underwriting, marketing, and operations departments. Typically has less than three years of experience.","D"]
[null,"3400","Director, Market/Competitive/Business Intelligence","Competitive Intelligence","Responsible for developing and managing a corporate strategic, primary intelligence system for information/insights on competitors, market changes, industry trends and regulatory issues. Works closely with leadership to determine the focus of key intelligence topics based on the strategic needs of the company, to evaluate and interpret intelligence information and insights, and to ensure that the primary intelligence needs of key policy and decision-makers are identified and satisfied in a timely fashion. Typically requires a minimum of 10-15 years' experience in collection, analysis, and the production of finished intelligence products.","T"]
[null,"3405","Manager, Market/Competitive/Business Intelligence","Competitive Intelligence","Manages the development and delivery of strategic and tactical information, analysis and recommendations/opinions concerning the organization's competitive position in the market place. Responsible for developing a strong team of consultants/subject matter experts who can act as project leaders on strategic and tactical projects/studies of varying scope, magnitude and complexity.","T"]
[null,"3410","Analyst, Market/Competitive/Business Intelligence","Competitive Intelligence","Responsible for planning, organizing, and conducting market and competitive intelligence projects through primary research methods. Interacts with internal departments on project basis. Leads/manages projects related to market and competitive intelligence. Requires Bachelor's degree, in Business, Research or Statistics and typically has 5 to 7 years CI/ MI industry and research, analysis and systems.","T"]
[null,"3450","Director, RFP","RFP","Responsible for organizing and managing the RFP team. Develops, implements, and executes strategies and plans to achieve annual and long-term goals. Participates in strategy meetings and works closely with the sales, marketing, underwriting, and operations departments. Typically holds a Bachelor's degree with seven or more years of experience."]
[null,"3455","Manager, RFP","RFP","Responsible for the daily operations of the RFP team. Assists in the development of RFPs and may participate in strategy meetings. Works closely with the sales, marketing, underwriting, and operations departments. Responsible for hiring, training, and firing staff. Typically holds a Bachelor's degree in a related area with six or more years of experience."]
[null,"3460","RFP Specialist - Senior","RFP","Under general direction, writes the responses to RFPs and may participate in strategy meetings with the sales, underwriting, marketing, and operations departments. May provide expertise and guidance to less experienced writers. Typically has three or more years of experience."]
[null,"3465","RFP Specialist - Associate","RFP","Under direct supervision, writes responses to RFP's and may participate in strategy meetings with the sales, underwriting, marketing, and operations departments. Typically has less than three years of experience.","D"]