Analyzes and designs work systems in order to support general adherence to agreed standards, in order to ensure humanely and economical production and drives continuous improvement topics. * Ensures analyses of materials and ingredients.* Ensures performing of prescribed chemical or biological procedures, in production environment.* Ensures adherence to established internal rules and guidelines, and to EHS standards. * Ensures taking protocols and storing in appropriate files. * Contributes to implement new testing, mixing procedures. "Expands"Needs to consider processes and results, generated in other workflows and disciplines, implies conditions and environments, and values significance to contribute effectively to team results. Needs experienced level of analytical and distinctive conceptual skills to solve issues given, which may differ in size and nature. 3-5 years Thorough professional know-how in one Sub Job Family, based on practical experience and theoretical foundation. Focus on applying and expanding acquired knowledge base. Application of knowledge in broader professional context. 1) well versed in Immunochemistry and Immunology (must have) 2) ELISA - thorough understanding of critical assay parameters and ability to troubleshoot (must have) 3) conducted independent research (must have) 4) experience with data analysis and writing technical study plans and reports (must have) 5) knowledgeable in protein purification techniques, including chromatography (must have) 6) effective communication both written and oral (must have) 7) experience leading improvement projects that increase the robustness, reproducibility, and compliance of the immunoassays (nice to have) 8) experience with root cause investigations and CAPAs, nice to have 9) experience with protein and antibody purification and labeling (nice to have) 10) industry experience (nice to have)
Locations Available for Position: Houston TX, Nashville TN, Birmingham AL Delivers specific delegated Customer Experience tasks assigned by a supervisor. Responds to inquiries from policy holders, providers and/or others for information and assistance. Responsible for daily review and processing needs from documentation received for Cigna MA Incentives program. Performs research to respond to inquiries and interprets policy provisions to determine most effective response while tracking customer responses. Position typically requires excellent interpersonal skills, ability to understand and interpret policy provisions. Independently responds to inquiries, grievances or complaints of moderate to substantial complexity. Completes day-to-day tasks without immediate supervision, but has ready access to advice from more experienced team members. Tasks involve a degree of forward planning and ability to use call scripts, spreadsheets, and various computer systems in order to assist customers in an organized manner.
Delivers professional activities in the Case Management job family. Coordinates member care needs across the continuum for assigned members who are medically stable, but require primary psychosocial support, acute intermittent medical support, or long term services support. Interviews members and relatives to obtain medical, behavioral, environmental and social history relevant to medical problems for health risk assessment and care planning. Assists members with environmental difficulties that interfere with obtaining maximum benefits from medical care. Serves as a liaison between primary care team, members, relatives and appropriate outside agencies. Applies standard techniques and procedures to routine instructions that require professional knowledge in specialist areas. Provides standard professional advice and creates initial reports/analyses for review. May provide guidance, coaching, and direction to more junior members of the team in Case Management.
Delivers technical, administrative, or operative Customer Service tasks. Performs data entry, sorts requests, and maintains files. Understands instructions and procedures. Performs Customer Service duties under direct instruction and close supervision. Work is allocated on a day-to-day or task-by-task basis with clear instructions.
See the attached Job Description Document and the Skills and Experience section for details.
Delivers straightforward administrative and/or other basic business services in Clinical Operations. Responsible for assembling and maintaining patients' health information in medical records and charts. Issues tend to be routine in nature. Good knowledge and understanding of Medical Records and business/operating processes and procedures. Works to clearly defined procedures under close supervision.
Role Summary: This role will be primarily responsible for addressing all internal and external business partner inquiries via email and phone regarding the CGI billing administration process. This incumbent will need to have a broad understanding of all functional areas with Revenue Management and committed to delivering a high quality level of customer service. Responsibiles: Provides daily internal and external customer service and inquiry resolution with key business partners. Acts as client's primary point of contact for billing/remittance related inquiries. Responsible for ensuring client is comfortable with the self-administered process and for calculation of premiums. Develops a broad understanding of all Revenue Management functions in order to address all client inquiries appropriately. This includes but not limited to premium validations, client onboarding, commissions and delinquency processes. Reviews, researches and supports the timely and accurate allocation and reconciliation of premium. Conducts premium reconciliation as required and resolves premium receipt discrepancies. Recognize and act on premium remittance inconsistencies to ensure that clients are in compliance to the billing administration process. Identifies and raises awareness of (and implements as applicable) process improvement initiatives. Interprets the billing administration and payment guidelines based on each types of policy and demonstrates proficiency in the understanding of policy difference of each as it relates to addressing client specific questions. Make recommendations for improvements and training based on trends. Conduct billing administration training calls. Review and educate clients on proper remittance support needed to accurately and timely process their payments. Navigates our associated banking platforms to research payments.
Accurate and expeditious verification of HealthCare Professional credentials Ensure all Health plan and National Committee for Quality Assurance requirements are met Knowledge of and compliance with NCQA and state specific standards Assist in the testing and implementation of procedures to improve efficiency Prepare Health Care Professional documentation for Credentialing Committee review Ability to exceed quality and production metrics Maintain provider profiling system Communicate via verbal and written means with providers and matrix partners This is not a call center environment, but does require communication with Health Care Professionals
Face to Face interview is mandatory* Role -In this pivotal role, the Customer Service Advocate receives inbound customer calls to answering general inquires on Family Medical Leave, Company Leaves, Americans with Disabilities Act, and New York Paid Family Leave. Additionally, they track all Family Medical Leave time reported and provide determination on time decisions. Creative problem solving, critical thinking and empathy skills are essential. Professional interaction, active and passive listening skills and the ability to utilize computer- based resources in a highly effective manner to educate and provide accurate responses to customer inquiries is crucial for success in the role, along with the innate ability to be compassionate and empathetic when appropriate when handling complex customer inquiries. Customer Service Advocate respond to customer inquiries primarily regarding: Eligibility associated with Federal, State and Company leave of absence plans, understanding of leave status, researching customer information and inputting data into designated system. Managing correspondence and notifications within targeted time frames to meet Department of Labor and Customer Performance Guarantees for Family Medical Leave (FML). Inputting intermittent Family Medical Leave (FML) time received into designated system, compares certification information against Business Requirement Documents, and renders determination.
See the attached Job Description Document and the Skills and Experience section for details.
The AppealsProcessing Lead Representativeis responsible for intake, processing of oral and possibly written grievances, conducting root cause analysis as needed, creating an action plan, coordinating and communicating resolutions, as well as documenting systems in detail with case notes related to Customer grievances. Skills Excellent oral, written communication skills & critical thinking ability required Ability to track and manage case load effectively in call tracking system Must be able to work independently and under pressure related to tight time-frames Problem solving skills required Working knowledge of MS Word, Excel and the ability to pick-up and work in multiple computer systems is required Customer-centric mindset
Perform review of the transaction received for credentialing, contracting and loading based on Center for Medicare and Medicaid Centers (CMS), National Committee of Quality Assurance (NCQA), IRS TIN Matching Program and Cigna Requirement and loading standards Outreach to the providers office for discrepancy and missing information and track information on tracking tool Partner with various matrix partners for resolution of issues including, but not limited to Credentialing, Provider Support Unit, Provider Development Management, Contracting and Provider Representatives Work with provider or group by phone, email, or mail regarding Onboarding status Schedule Cigna outreach follow-up requirements Meet individual and department metrics Job involves a high degree of complexity and business logic
Please do not submit any candidates previously rejected on Req #9468375*Delivers specific delegated Provider Data tasks assigned by a supervisor. Maintains provider data to ensure the quality of the network. Responsible for accurate and timely maintenance of critical provider information on all claims and provider databases. 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. Completes day-to-day Provider Data tasks without immediate supervision, but has ready access to advice from more experienced team members. Tasks involve a degree of forward planning and anticipation of needs/issues. Resolves non-routine issues escalated from more junior team members. This role is supporting primarily for PPO Expansion. Worker will: Track Data and PPO Contracts Upload contracts to repository May update databases If time allows, there are a number of other projects going on that the worker could be involved in. Interviews will be first round phone interviews and second round will be in person
Do not submit duplicate candidates or previously rejected candidates on req #9805316* Provide office services by assisting with multiple databases, file folders, and update information as required. He or She will provide administrative support to multiple departments in a high volume and fast pace environment, which is helpful in accomplishing the team effort and related results as needed. He or She will have to provide information by answering questions and request using proper verbal or written communication. Also, have the ability to resolve administrative problems by analyzing data and identifying solutions. In addition, he or she will also be accountable for archiving outdated records, and review reports for accuracy. All individuals will also be responsible for clerical support such as faxing and photocopying. Completes operational requirements for administrative projects; expediting work results. Answer questions about records and files Retrieve, sort, and file all information about records and files. Read all kinds of incoming material to establish location of file folder Gather materials to be filed from departments and employees Retrieve, sort, and file all information Maintain and arrange file room Maintain a day by day productivity log of file deliveries and etc. Interact with employees throughout campus Copy and fax, hand out reports and memos Sort material in accordance with filing system used Collect materials to be filed from company and staff Stamp files and materials received Place essential papers and materials in files Help other office workers Gather materials to be filed from departments and employees. Must be able to lift up to 35lbs
The Case Management Technician functions under the direction of the Supervisor, Care Coordination to conduct screening for case management services and to identify member needs for Care Coordination, and implement selected interventions according to program guidelines for members. Interacts with members, providers, and other Cigna staff to implement the program interventions, track and document the members progress, and evaluate the individual member outcomes. The Case Management Technician participates as assigned in performing outreach calls to: Identify members immediate and future CM, Special needs, and Disease Management needs Improve and/or maintain the members health status and quality of life. Educate and empower the member to become effective in the self-management of their chronic illness. Increase members adherence to program guidelines by plan physicians The Case Management Technician interacts with members, providers, and other Cigna staff to implement selected program interventions, document the activities, and refer to professional staff as appropriate and according to protocols Conducts outbound member calls following scripted protocols meeting both productivity and performance expectations as identified by unit supervisor. Conducts all calls in a courteous and customer service friendly manner. Verifies member eligibility in the Care Coordination program according to program guidelines. Documents agreement to participate in Care Coordination program according to prepared script and protocols. Using good listening skills conducts outreach calls collecting specific clinical and baseline data according to script, tools, and protocols. Refers member to a case manager when indicated by members response to questions. Communicates directly with members in the Care Coordination program to identify needs, and provide information on health care access and preventive health interventions and screening. Establishes member specific interventions to be provided according to program guidelines, and care plans. Collaborates with member, Complex Case Manager RN/MSW, and Account Manager/Care Coordinator, and reports on member progress. Enters member data into various software platforms. Routes case to appropriate Cigna associates based on established guidelines. Communicates case specific information as indicated to providers. Information includes, but is not limited to member identification number, status of health screens and immunizations. Assists members with: obtaining physician appointments, and resolving transportation issues. Assists with the delivery of program materials to the members Assists with the generation and delivery of member correspondence Documents activities and required data for the purpose of outcome measurement and reporting and program CQI. Participates in program development activities and project work. Performs other duties normally associated and consistent with this position including, but not limited to maintaining applicable regulations and standards required in the performance of this position, participating in regular continuing education, updating and developing policies and procedures, attending in-house meetings and rounds, etc. Performs other related duties and projects as assigned. Adheres to Cigna policies and procedures. Supports and carries out the Mercy Mission & Values. Attends required training on an annual basis. Complies with Cigna and HIPAA confidentiality standards to protect the confidentiality of member information.