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Plans and directs Medicare operations including claims, information systems, purchasing, and facilities to ensure processing of the health plan's Medicare claims. Ensures that all operations meet the plan's objectives and requirements relative to Medicare members and providers. Directs the implementation and ongoing maintenance of claims handling systems, policies, and procedures. Typically requires a college degree and five or more years of Medicare claims management experience.: Monitors departmental operations to ensure compliance with regulatory agencies as well as contractual obligations. Performs regular data analysis of claims payment reports to identify variances so that areas of focus may be identified and resources may be appropriately deployed. Prepares and manages the departmental budget and manages expenses. Hires, develops, and motivates a qualified claims processing staff. Provides support on complex claims issues.
Manages Medicare Service Representatives within the Medicare Membership function in a health plan. Monitors departmental statistics, reports results and develops action plans that address deficits. This position typically requires five years of health plan experience in a customer service call center.: Manages Medicare Service Representatives within the Medicare Membership function in a health plan. Implements policies and procedures within the Medicare Membership department to ensure provision of accurate explanation of benefits and response to Medicare members’ questions and complaints. Plans, implements and continuously evaluates the Medicare member service program to enhance the effective use of services and to improve customer satisfaction. Instructs departmental staff on proper member service procedures and monitors service levels. Researches and evaluates complaint reports to detect patterns, formulate solutions and report needed actions to appropriate individuals, departments or committees. Works with Medicare members on complex issues to offer mutually acceptable alternatives to problems and complaints. Responsible for hiring, developing and managing a qualified staff concerned with providing member service to Medicare members of the health plan. Assists in the preparation and management of the departmental budget. Monitors departmental statistics, reports results and develops action plans that address deficits. This position typically requires five years of health plan experience in a customer service call center.
Maintains bank's balances on deposit in foreign banks to ensure foreign exchange position, and negotiates prices at which such exchanges shall be purchased and sold, based on demand, supply, and stability of currency. Refers to international bank market rate to determine foreign exchange rates. Establishes local rates based upon international bank rates, size of transaction involved, stability of market, and bank's balances available to fund customer requirements. : Negotiates purchase and sale of foreign exchange drafts on foreign exchange market and calculates US dollar equivalents. Adjusts deposit balances with foreign banks. May direct foreign exchange personnel in transactions relating to international monetary business.
Inspects and services new automobiles on delivery to dealer or customer, and makes minor repairs or adjustments to place vehicle in salable condition, using hand tools, portable power tools, and specification sheets. : Inspects vehicle for obvious damage and missing major components. Records discrepancies and signs acceptance slip for each vehicle delivered. Inspects vehicle for loose or misaligned items, such as trim, doors, and hardware, and positions defective items according to specifications, using hand tools. Starts engine and drives automobile to test steering, brakes, transmission, and engine operation. Activates power equipment, such as electric windows, seats, radio, horn, lights, and directional signals to ensure specified operating standards. Washes car and vacuums interior. Inspects surfaces to detect minor chips and scratches in paint and touches up imperfections, using brush applicator and factory-supplied matching paint. Installs optional equipment specified by customer or dealer, such as outside mirrors, rugs, and seat covers, using hand tools. Installs standard components, such as hubcaps and wiper blades, using hand tools. Pours antifreeze into radiator according to seasonal requirements. Polishes car to remove preservative coating and road film accumulated during transit. May spray undercoating material on vehicle, using spray gun. May tune engine, using mechanic's tools and test equipment. May install or repair major mechanical, hydraulic, or electromechanical equipment, such as radios, air-conditioners, power steering units, and power brakes, using mechanic's hand tools.
Works with builder to sell new homes to buyers. Understands the home building business and how to use consumer psychology and advanced techniques for greeting prospective clients, overcoming objections, closing the sale, and following up the sale with client. Interviews prospective clients and accompanies prospects to property sites. Shows homes under construction to describe and display construction features and quality of work, quotes purchase price, and discusses conditions of sale. Reviews plans and specifications for custom-built homes with client and architect to clarify costs and construction details in preliminary negotiations for contract. Recommends construction features and available decorating options, such as cabinet installations, to aid client in formulating plans. Answers questions regarding work under construction.: Possesses knowledge of the basic steps of the builder's decision making and development process, basic construction features that benefit the home buyer, builder's marketing approach, the impact the New Home Salesperson has in the marketing process, and the impact of consumer behavior on the new home selling process. Uses basic elements of effective communications in the selling environment and understands the importance of prospecting in searching for and qualifying potential buyers. Knowledgeable of the legal aspects of the real estate business, fair housing guidelines, and details of basic new home financing. Draws up real estate contracts, such as deeds, leases, and mortgages. Participates in final walk-through and handles required call-back issues. May assess clients' financial status to determine eligibility for financing home through contractor.
Inspects new cars prior to loading onto carriers: examines car for scratches, dents, and broken glass. Drives car to detect motor noises, transmission malfunctions, and brake failure. Records findings. Drives cars onto trailer truck. Keeps record of cars until delivery.
Interviews customers applying for charge accounts: confers with customer to explain type of charge plans available. Assists customer in filling out application or completes application for customer. Reviews applications received by mail. Files credit applications after credit department approves or disapproves credit. May check references by phone or form letter and notify customer of acceptance or rejection of credit credit clerk. May verify entries and correct errors on charge accounts customer-complaint clerk, using adding machine. May answer credit rating requests from banks and credit bureaus. May issue temporary shopping slip when credit references appear satisfactory.
Opens accounts, explains and processes investments and other financial services, researches account problems, resolves complaints, and corrects records. Interviews customers to obtain information and explain available financial services, such as savings and checking accounts, Individual Retirement Account, Certificates of Deposit, savings bonds, and securities. Rents safe deposit boxes. Job know-how usually involves one to two years of directly related study, training, and/or experience.: Answers customers' questions and investigates and corrects errors, following customer and establishment records. Presents funds received from customer to teller deposit, and obtains receipt for customer. May help customer complete loan application. May type account information obtained from customer on record card or form and enter it into computer. May obtain credit records from credit reporting agency. May admit customers to safe deposit vault. May execute wire transfers of funds.
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