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Contract Compliance Representative (Entry)

Determines provider compliance throughout a region and recommends appropriate actions.: This position is typically responsible for learning 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. Conducts ad hoc investigations. This position typically requires at least one year of underwriting experience.

Contract Compliance Representative

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. Conducts ad hoc investigations. This position typically requires a college degree in math, economics or a related field and three years of underwriting experience.

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.

Provider Relations Representative

Monitors and coordinates governmental or private health care programs to ensure quality health care and facilitate claim processing; and negotiates contracts for health care programs between insurance companies and health care providers: Analyzes reports and documents regarding health care usage of program participants, utilizing computer; compiles list of recurring health care claims processing issues; develops agenda to address issues; and conducts information and training workshops with employees who process and file claims to resolve claim processing errors. Formulates contract draft of agreement between participants of health care program, utilizing information, such as standard agreement procedures, insurance company policies, and governmental requirements, using computer. Presents health care program contracts to participating parties, discusses modifications suggested by parties involved, and obtains signatures of required representatives on new, renewed, or revised contracts. May monitor phone calls received by medical claim processors to evaluate services offered by employees. May investigate and resolve medical care provider claims reimbursement and program procedural problems. May review evaluation forms completed by workshop participants to determine whether workshop presentation covered processing errors. May specialize in contract negotiations or serve as consultant to facilitate claim processing and be designated Provider Services Specialist (government ser.; insurance; medical ser.).

Hospital Insurance Representative

Interprets hospital and medical insurance services and benefits to contracting hospital personnel. Discusses contract provisions and hospital claims forms with medical and hospital personnel. : Instructs hospital clerical staff in resolving problems concerning billing and admitting procedures. Writes reports outlining hospital and contract benefits for incorporation into brochures and pamphlets. May travel from city to city.

Help Desk Representative

Analyzes and troubleshoots computer support problems and applies understanding of computer software and hardware products and services to resolve problems of users. Receives telephone calls and e-mails from users having problems using computer software and hardware or inquiring how to use specific software, programming languages, electronic mail, or operating systems. Ascertains from computer user the nature of problem, determines whether problem is caused by hardware such as modem, printer, cables, or telephone, formulates diagnosis, and assists users through problem solving steps. Organizations usually prefer two years of postsecondary training in field of specialty; however, some companies may accept equivalent education and experience combined.: Talks with co-workers to research problem and find solution. Tests software and hardware to evaluate ease of use and whether product will aid user in performing work. Writes software and hardware evaluation and recommendation for management review. Writes or revises user-training manuals and procedures. Develops training materials, such as exercises and visual displays. Trains users on software and hardware on-site or in classroom, or recommends outside contractors to provide training.

Sales Executive Technical Sales

Directs activities, either directly or through subordinates, concerned with sales of products or services of a highly complex nature. Plans, develops, establishes, and implements policies, procedures, and objectives of technical sales function in accordance with objectives of organization. Confers with organization officials to plan technical sales objectives, to develop sales policies, and to coordinate functions. Develops and maintains accounts and responds to bids and proposals. Targets and develops clients through existing database and contacts, advertising resources, and the Internet. Meets with clients to evaluate their technical needs and to recommend and provide consulting solutions.: Analyzes and interprets records of present and past sales, trends and costs, estimated and realized revenue, administrative commitments, and obligations incurred for management. Examines estimates of material, equipment, and production costs, performance requirements, and delivery schedules to ensure completeness and accuracy. Evaluates the market position of competing technical products, services, and organizations and their marketing and sales techniques. Devises sales strategies and promotions to obtain maximum sales volume. Forecasts semi-annual and annual sales projections. Directs preparation of required reports. Interprets and enforces company policy and practices. Ensures the adequacy of sales training programs. May recruit, hire, train staff, evaluate employee performance, and recommend or initiate promotions, transfers, and disciplinary action.

Sales Associate For Wireless Sales

Sells new wireless products and services. Assists new and existing customers with the purchase of wireless equipment and services. Presents products and services to prospective customers through demonstrations and development of wireless communications solutions.: Prospects and generates new sales opportunities. Conducts all required processes and procedures to implement new service upon completion of sale. Initiates follow-up contact with customers to ensure complete satisfaction with all products and services purchased. Participates in the development and execution of promotional activities. Responds to customer inquiries, needs, and/or problems, which may include account research, explanation of equipment operation, and execution of warranty claims. Stays current with changes and developments in the wireless industry.

Business Development Representative

Supports business development and marketing of the organization's products by maintaining records and promoting products to brokers, third party administrators, self-funded employers, and Human Resources Departments. A bachelor's degree in marketing is typically required for this position with two years of business development or marketing experience.: Maintains the Business Development databases that include proposals, budgets, project costs and analyses, letters, mailings, and contracts. Produces monthly management reports and supports client service and marketing activities. Supports business development activities by assisting with the contracting and marketing of such activities to existing and potential clients. Assists management in the development of business plans, marketing strategies, sales calls, and general marketing of the business development activities of the organization. Conducts ongoing research of new product lines, making recommendations to the appropriate individuals. Facilitates efforts to develop, implement, and refine standard procedures for researching, collecting, and tracking information about clients including contact data, pipelines, and previous outsourcing experiences.

Veterans Contact Representative

Advises and aids veterans or dependents in presenting disability, insurance, or pension claims for benefits under Federal, State, or local laws. : Reviews legislation, regulations, and precedents and studies veteran's medical report and service history to evaluate and determine validity of claim. Obtains claimant's power of attorney. Prepares claim forms and briefs and assembles pertinent evidence. Requests hearing before government board and presents brief. Reviews board decision for grounds for appeal. Advises veteran on insurance, vocational, and other matters, working in cooperation with Veterans Administration and other agencies. Prepares bulletins and correspondence to acquaint field representatives with current activities and legislation. Participates in or initiates civic functions, such as panel discussions and mass communication programs, to inform public of services rendered and rights and benefits of veterans and dependents. May offer technical advice at congressional or other governmental hearings.

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