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Director Customer Service

Directs employees, through subordinate levels of management, engaged in receiving calls and inquiries, investigating, evaluating, and settling complaints and claims of customers. Assists the Customer Service Top Officer in planning, formulating customer service policies, and directing and coordinating the company's customer service activities. Typically reports to Customer Service Top Officer and Customer Service Managers may report to this position.: Providing administrative support to sales activities may be part of the director's responsibilities. Such administrative support activities may include, but are not limited to, processing customers orders, supplying price quotations, supplying product information, keeping sales statistics, and other related activities. Oversees the investigation of complaints, such as those concerning rates or service in connection with any product or service offered. Analyzes reports of findings and recommends response to complaint, considering nature and complexity of complaint, requirements, actions of subordinates to ensure settlements are made correctly. Authorizes retention of data and preparation of documents for use during governmental or customer inquiries.

Customer Service Top Officer

Plans, develops, and establishes policies and objectives of customer service in accordance with objectives of organization. Reports, typically, to Chief Operating Officer and has Director Customer Service reporting to this position.: Confers with organization officials to assure customer service objectives are in concert with business plans and objectives. Develops organizational customer service policies and coordinates related functions. Directs and coordinates customer service programs and activities. Explains firm's customer service programs and how use of programs can promote customer relations and sales. Directs employees engaged in customer service who may provide product support, investigate, evaluate, and settle complaints and other related programs. Directs customer service employees concerning products, rates or service in connection with products or services offered. Analyzes reports of findings and recommends response to customer service issues considering nature and complexity of the issue. Directs the activities and actions of subordinates to ensure customer service issues are handled correctly. Authorizes retention of data and preparation of documents. Prepares activity reports for evaluation by management.

Contract Compliance Representative (Mentor)

Determines provider compliance throughout a region and recommends appropriate actions.: This position is knowledgeable of investigatory techniques for the detection of inadvertent or intentional fraud. Assists in special investigations and provides support in compliance with requests from enforcement agencies. Researches, handles and assists in resolution of complaints regarding suspected fraud and/or compliance issues. Analyzes documentation and summarizes data gathered from a variety of sources. Interacts with other departments and performs special tasks to include overseeing random examination processes, enforcing membership actions and assessing reports on provider groups or brokers. Provides first line oversight to less experienced Contract Compliance Representatives. Conducts ad hoc investigations. This position typically requires a college degree in math, economics or a related field and at least five years of underwriting experience.

Customer Service Manager

Manages by directing and coordinating subordinate customer service staff in connection with any product or service offered. Manages workers who investigate complaints, such as those concerning rates or service. Analyzes reports of findings and recommends response to complaints, considering nature and complexity of complaints, requirements, and actions of subordinates to ensure settlements are made correctly. Typically reports to director level and may have supervisory positions reporting to this position.: Studies schedules and estimates time, cost, and labor estimates for services, and/or completion of job assignments. Develops and implements methods and procedures for monitoring work activities, such as preparation of records of expenditures, progress reports, etc., in order to inform management of current status or work activities. Analyzes department budget to identify budget needs and/or reductions, and may allocate operating budget's funds. Interprets company policy to employees and enforces company policy and practices. May authorize retention of data and preparation of documents for use during governmental or customer inquiries. May recruit, hire, train staff, evaluate employee performance, and initiate promotions, transfers, and disciplinary action.

Nurse Case Manager (Mentor)

Plans, directs, implements and evaluates appropriate healthcare services in conjunction with the physician treatment plan to ensure that cost effective, quality care is provided.: Case coordination normally includes prospective and retrospective review which includes prior authorization, determining the appropriate level of care and utilization of services, concurrent review, retrospective review, developing discharge plans, and ensuring quality cost effectiveness. Develops a plan of care for patients from admission to discharge. Monitors patient progress toward desired outcomes through assessments and evaluations. Develops and administers education and prevention programs. Analyzes referred cases for potential case management interventions. Evaluates the effectiveness of alternate care services and ensures that cost effective, quality care is maintained to meet case management objectives. Determines if proposed medical treatment plans meet contract provisions. Authorizes initiation of medical case management. This position typically requires a licensed Registered Nurse with a minimum of five years of relevant nursing and medical case management experience. Certification as a case manager or professional certification in a clinical specialty may also be required. May arrange referrals, consultations, therapeutic services, and confer with other specialist on course of care and treatment. May negotiate fees with providers of medical care, agencies and outside vendors to achieve maximum cost effectiveness. May provide guidance to less experienced case managers.

Laboratory Technician (Mentor)

Performs routine and complex tests in medical laboratory to provide data for use in diagnosis and treatment of disease.: In a senior capacity, conducts quantitative and qualitative chemical analyses of body fluids, such as blood, urine, and spinal fluid, under the supervision of Medical Technologist. Trains and guides less experienced Medical Laboratory Technicians. Prepares sterile media and plates, jars or test tubes for use in growing bacterial cultures. Prepares solutions, reagents and stains, following standard laboratory formulas and procedures. Maintains detailed records of tests performed and reports laboratory test results to appropriate personnel. Calibrates and performs routine maintenance on equipment to ensure proper functioning. Cleans and sterilizes laboratory equipment, glassware and instruments. Collects blood specimens from patients using venipuncture or stick. Performs blood counts, using microscope. Conducts blood tests for transfusion purposes. May draw blood from patient's finger, foot, ear lobe, or vein, observing principles of asepsis to obtain blood samples. May specialize in hematology, blood bank, cytology, histology, or chemistry.

Clinical Research Technician (Mentor)

Designs, conducts and interprets a variety of complex clinical research experiments in the laboratory.: Conducts more complex laboratory testing involving medical research. Develops procedures for use in research protocols and experiments. Prepares equipment and aids scientist during tests and examinations. Maintains the laboratory and ensures availability of required supplies and equipment. Performs administrative duties in the laboratory to include maintenance of records and report preparation. Maintains laboratory equipment. This position typically requires an advanced degree in health sciences and five years of clinical research experience. This level may require completion of Clinical Research Professional exam. May provide input into the final report.

Enrollment Representative (Mentor)

Responds to incoming calls and verifies enrollment status, makes changes to records, researches and resolves enrollment system rejections, and addresses a variety of enrollment questions or concerns received by phone or mail.: Independently resolves enrollment inquiries using standard policies, procedures, and guidelines. Verifies enrollment status, makes changes to records, and researches and resolves enrollment system rejections. Addresses a variety of enrollment questions or concerns received by telephone or mail. Provides enrollment information to callers and responds to inquiries concerning enrollment processes. Maintains enrollment database. Investigates data errors. Orders identification cards and responds to routine questions and problems regarding eligibility or membership changes, issues or concerns. This position typically requires three years of enrollment experience.

Customer Facilities Supervisor

Supervises and coordinates activities of workers engaged in installation, repair, and maintenance of telephone facilities, such as private and public telephones, switchboards, teletypewriters, and related electromechanical equipment: inspects customer's premises to determine location of telephone and installation procedures. Directs installation of telephones and auxiliary equipment, such as brackets, wires, and clamps. Connects wiring to outside cable terminals, tests installed instruments and circuits continuity or to locate malfunctions, using tone and flicker sets. Directs workers in repair or replacement of faulty equipment. Performs other duties as described under supervisor. May be designated according to particular activity supervised as installation supervisor; transmission-maintenance supervisor; or manager, prorate when supervising equipment inspector in rural areas.

Health Data Analyst (Mentor)

Develops and maintains clinical software applications. Designs, produces, and analyzes health data reports.: Analyzes, develops, and maintains complex computer applications, procedures and other systems that satisfy the needs of the clinical user departments. Creates complex data queries to produce datasets for the analysis of medical costs and utilization trends. Analyzes and develops complex design work, including testing and documentation. Performs data validation studies. Designs, produces, and interprets changes in data trends and serves as the impetus for further investigation. Reviews, evaluates and implements requests from clinical user departments. Trains less experienced analysts. Oversees computer applications to ensure proper use and security. Analyzes problems, determines cause and initiates corrective action. Develops clear and concise documentation and instruction manuals. Provides in-service training and other forms of continuing education of software and hardware to users. Coordinates and installs new software applications with user departments. Maintains a high level of interaction with all clinical areas to continually enhance and improve patient care. This position typically requires a college degree and four years of experience with clinical computer information systems and analysis.

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