Complaint Evaluation Supervisor Job Description Sample
Complaint Investigation Supervisor
Johnson & Johnson Surgical Vision (JJSV) is recruiting for a Complaint Investigation Supervisor in JJVS is Milpitas, California.
JJVS designs, manufactures, and distributes products for the surgical treatment of anterior segment ophthalmic disorders, most notably cataract removal. Caring for the world, one person at a time has inspired and united the people of Johnson & Johnson for over 125 years. We embrace research and science -- bringing innovative ideas, products and services to advance the health and well-being of people. Employees of the Johnson & Johnson Family of Companies work with partners in health care to touch the lives of over a billion people every day, throughout the world.
The Johnson & Johnson Surgical Vision goal is improving sight throughout a patient's lifetime. J&J Surgical Vision is well positioned to address a full range of vision health needs for global markets: The No. 2 global provider of CATARACT products and a leader in presbyopia-correcting IOLs, the Global REFRACTIVE (LASIK) market leader, all supported with a CONSUMER EYE HEALTH diverse portfolio of solutions and drops. Johnson & Johnson Surgical Vision has operations in the United States, Latin America, Asia-Pacific and Europe/Middle East/Africa regions. Research, innovation and new-product development are the focus of our organization. Our associates around the world are committed to expanding our brands and fortifying our position as the worldwide leader in the industry.
The Complaint Investigation Supervisor will:
Oversee, maintain and improve the complaint investigation program, including returned product analysis. Runs the day to day complaint investigations team related to the medical devices manufactured and/or distributed.
Serves as the primary contact for processing and reporting product complaint investigations.
Coordinate the process for complaint investigations and resolution, including returned goods evaluations, review of manufacturing records, decontamination, and inspection of samples, manufacturing processes and DHR review, and testing as appropriate.
Ensure complaint investigations metrics are met.
Review complaint investigations
Leads complaint investigation projects
Achieve technical and stylistic consistency between and among investigation documents to prevent contradicting information.
Collaborates with other groups such as engineering, clinical, regulatory and marketing to ensure a thorough and accurate complaint investigation.
Continually provide mentorship to all employees for handling complaint information
Other responsibilities included but not limited to:
Assist in preparing for Management Review presentations and supporting documentation as requested.
Assist in preparing for internal and external audits and inspections as needed.
Train and mentor other members of the QA team, as appropriate.
Johnson & Johnson Family of Companies are equal opportunity employers, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, genetic information, national origin, protected veteran status, disability status, or any other characteristic protected by law.
A minimum of a Bachelor's Degree is required
A BS degree in Mechanical or Electrical Engineering is strongly preferred.
A minimum of 5 years of complaint investigations experience is required.
Previous management or supervisory experience is strongly desired.
Project Management experience is strongly preferred.
Quality Systems experience is preferred.
Experience with capital equipment is required.
CATS Web or ETQ system experience is a plus.
Ability to partner and work well with others is required.
Effective written and oral communication skills are required.
Previous experience in the Medical Device or another highly regulated industry is preferred.
This role is located in Milpitas, CA and may require up to 10% travel, both domestic and international.
AMO Manufacturing USA, LLC (6240)
Auditor 4 – Real Estate Program, Audit Unit Supervisor/Investigations & Complaint Intake
Skilled Auditor? Experienced Leader? Ready for a new challenge?
The Department of Licensing has an opportunity for you to manage our Real Estate Audit Team, supervising staff and overseeing all projects to ensure the safekeeping of public funds held in trust in accordance with state law and department policy by providing the enforcement and compliance functions. This statewide audit team engages licensees in the field to ensure compliance with statute/rule through education and regulation to enhance and promote public safety and consumer protection.
We are looking for a skilled auditor/investigator and experienced leader who enjoys supervising, training, and evaluating operating practices, maintaining quality control, overseeing fieldwork performing audits/investigations, communicating findings, and making recommendations to staff and management. Our ideal candidate is ready to supervise a team and is equipped to lead, train, mentor, and develop others. They have superior research, analysis, and report writing skills. And they are astute at identifying, evaluating, and resolving customer concerns, and have strong communication skills with experience using plain-talk principles to explain complex laws, rules, and policies to diverse audiences in a regulatory environment.
Prior to a new hire, a background check including criminal record history will be conducted. Information from the background check will not necessarily preclude employment but will be considered in determining the applicant's suitability and competence to perform in the position.
What our Real Estate Audit Supervisor does:
Reporting to the Investigator Manager within the Real Estate Investigation unit in the Business Profession Division (BPD), this position will:
Direct and delegate BPD Auditors in teams or as individual assignments, conducting complex audits and investigations dealing with fraud, theft and conversion of trust funds, and unlicensed practice for the Real Estate licensees, Bail Bonds, Sellers of Travel, Camping Resorts, Auctioneers, Collection Agencies and Cosmetology when audit support is requested and using the guidelines of an established profession.
Supervise, manage and lead a team of Auditors with initial authority for approval/disapproval of audit and investigation reports submitted by the audit team.
Assist staff with technical requirements during the course of their audits/investigations from inception to closure and/or hearing testimony.
Responsible for workload prioritizing and assigning auditors to assist with investigations in order to maximize unit performance in production timelines and audit quality.
Establish priorities, monitor workflow, modify work processes to maximize efficiency, schedule work shifts, time and attendance, approve leave, work schedules, available and responsive to staff and management, ensure adequate staffing levels, manage and ensure accountability and training are a part of the overall supervision provided to the audit unit by the Audit Supervisor.
Perform all functions for the team: making hiring recommendations, teaching, training, monitoring and coaching, evaluating performance, and delegating to and supporting a staff full range of audit skills and experience necessary to fully plan and conduct multi-facet complex financial audits and investigations.
Assist in developing audit unit policies, procedures, and best practices and implementing unit, division, and agency policies.
Develop, implement, conduct and evaluate training opportunities for auditors to assist the team in achieving the highest professional standards.
Provide assistance to management staff, assistant attorney general staff in preparing cases for administrative hearings.
Establish criteria for case referrals, criminal and administrative by identifying proper agency for referral. Evaluate case files on an as needed basis for referral. Coordinate and assist in auditors in facilitating case referral.
Remain knowledgeable and current regarding the content, interpretation and application of applicable statutes and federal statutes and directive. Keep abreast of evolving policies, guidelines, civil court decisions and legal interpretations related to government policies.
Maintain liaison with regulatory officials in other jurisdictions and enforcement agencies, private businesses, professional associations and industry trade associations.
Interact with internal and external groups and organizations, including customers, stakeholders, licensees, consumers, assistant attorney general, law enforcement, and management throughout division and agency.
Applicants who possess the following qualifications may be referred to the hiring manager:
Five years of experience supervising, coaching, and leading groups.
Five years of experience interpreting and applying Washington State Statutes, Rules, or Federal Regulations.
Five years of experience in gathering, preserving, and presenting financial audit findings in a complete comprehensive report to allow program, division, or department management to proceed with appropriate adjudication.
Five years of experience using sound human resource principles to effect timely resolve concerns, issues, or problems within a work unit.
Applicants who also possess the following may receive additional consideration by the hiring manager:
One (1) year of working experience in the following areas:
Knowledgeable of the statutes, rules, practices and principles of Real Estate Brokers, Managing Brokers, and Firms.
Effectively organizing multiple assignments, sometimes of a complex nature or involving competing priorities, to produce work products that are accurate, thorough, and on time.
Proven management experience over financial audit caseloads, and managing staff.
Knowledge and understanding of the practices, principles, and standards of care for real estate firms, managing brokers, and requirements for effective consumer trust account compliance.
Willing and able to be self-sufficient and work independently.
Bachelor's degree involving major study in business, accounting, or closely aligned field or completed education requirements and been licensed as a real estate broker or managing broker.
Ability to work a flexible schedule and adjust daily work hours as needed.
Ability to work beyond 40 hours as required, including some evening and weekend work.
Ability to travel statewide and locally including overnight travel using a state or personal vehicle.
Work in an office setting and outdoors.
Why work at DOL?
We impact more citizens directly than any other state agency and have a strong mission, vision, values, goals and agency culture. We are focused on our commitment to great service, advancing public safety and consumer protection through licensing, regulation and education and collecting revenue that supports our state's transportation system. We are a diverse organization that values integrity, inclusion, respect, results and service excellence. And we have a positive agency culture where employees are engaged, empowered, and appreciated. Find out what our own employees have to say about DOL's Culture and Diversity!
We also value wellness and promote a family-friendly culture where a healthy work life balance is supported. And, in addition to our State's excellent benefits package, we offer an outstanding tuition assistance program! Come enjoy life in Olympia, Washington! Olympia was named one of 2018's Top 100 Best Places To Live by Livability.com. Learn more about life in the capital city!
This position is included in a bargaining unit represented by the Washington Federation of State Employees (WFSE). For membership questions, contact the local Union Representative.
How to Apply
To be considered for this position, the following steps are required:
Select the large Apply button at the top of this job announcement. If you haven't already done so, you will need to create an applicant profile.
Ensure the work history section of your applicant profile is current and thorough, clearly stating any and all qualifications you possess related to this specific position, as well as your current salary information.
Upload and attach your cover letter specific to this position and your current resume. Your materials must also include three professional references with name, title, and current contact information. References may be listed in your applicant profile, included on your resume, or uploaded as a separate attachment. Additional references are accepted.
You are welcome to include the name and pronoun you would like to be referred to in your materials and we will honor this as you interact with our award-winning diverse and inclusive organization.
If you have any questions or need assistance completing the application process, contact the recruiter listed below prior to when this job posting closes AND before you submit your application.
Veteran's Preference Notice
To take advantage of veteran's preference, please do the following:
Email a copy of your DD214 (Member 4 copy), NGB 22 or USDVA signed verification of service letter to HRRecruit@dol.wa.gov
Use a subject line of "VET for BPD AUD 4 –Real Estate 19-024"
Include your name as it appears on your application in careers.wa.gov
The candidate pool certified from this recruitment may be used to fill future similar vacancies for up to six months.
The Washington State Department of Licensing is an equal opportunity employer and does not discriminate on the basis of age, sex (including gender identity), marital status, sexual orientation, race, creed, color, national origin, honorably discharged veteran or military status, or the presence of any sensory, mental, or physical disability or the use of a trained dog guide or service animal by a person with a disability. Persons requiring accommodation in the application process, during the recruitment process, or who need this job announcement in an alternative format, may contact the Human Resources Office at 360-902-4000 or may email HRRecruit@dol.wa.gov. Applicants who are deaf or hard of hearing may call our ASL interpreter via Video Phone at 360.339.7344.
For inquiries about this position, please contact at 360.902.4061 or email HRRecruit@dol.wa.gov. Please use a subject line that includes "BPD AUD 4 19-024 Real Estate"
Customer Advocacy And Complaint Specialist
Role: Customer Advocacy and Complaint Management Specialist
Location: Wyomissing PA
Manager: Customer Advocacy and Complaint Management Officer
The primary role of the Customer Advocacy and Complaint Management Specialist is to conduct and assist in the investigation, root cause identification, customer impact analysis and the formulation of responses to complaints received from the Bank's regulators, Executive customer complaints, and other escalated level complaints as identified. The role includes implementation of processes to analyze data in context, identification of potential solutions to identified root cause issues, report creation for presentment to upper management and other duties as assigned.
Actions to Be Successful in This Role:
§ Conduct and provide support for all aspects of evaluation of customer complaints for Customers Bank and BankMobile
§ Craft and provide support in crafting of summary and response memos to Management, the Bank's regulator and/or responses to any escalated complaints received from different sources
§ Identify root cause issues, devise resolutions to individual customer issues (as needed), and rapidly troubleshoot and propose solutions to root cause issues
§ Work with other business units to address root cause issues and assist in fostering understanding of concerns
§ Perform all duties in a context of the prevention and detection of regulatory non-compliance and/or consumer harm including acting as an advocate for customer interests in those pursuits
§ Assist with the creation of monthly reporting and summation of customer complaints
§ Assist with any audit requests and responses
§ Help maintain departmental procedures
§ Provide exceptional customer service to internal and external customers
§ Perform projects and other duties as assigned
§ Excellent customer service skills
§ Outstanding oral and written communication skills
§ Positive attitude and Team player
§ Flexibility and the ability to adapt quickly to the changing needs of Compliance, Customers Bank and BankMobile
§ Ability to work independently and to multi-task
§ Excellent time management skills
§ Strong analytical and problem-solving skills
§ Knowledge of federal and local banking regulations
§ Detail oriented
§ Proficiency in Microsoft Office – Word, Excel, Outlook
Customers Bank Culture:
At Customers Bank, we believe in working hard, working smart, working together to deliver memorable customer experiences and having fun. Our Vision, Mission, and Values guide us along our path to achieve excellence.
Passion, attitude, creativity, integrity, alignment, and execution are cornerstones of our behaviors. They define who we are as an organization and as individuals. Everyone is encouraged to have personal development plans. By doing so, our Team Members are on their way to achieve their highest potential and be successful in their personal and professional lives.
Customers Bank will provide consideration for employment to qualified applicants without regard to their race, color, religion, national origin, sex/ gender, protected veteran status or disability.
Medicare Auditing And Complaint Specialist
Medicare Auditing & Complaint Specialist: The ideal candidate is a self-starter who is
detail oriented, works well with other team members, is well organized, and has strong time management skills.
Be familiar with the forms of possible government and commercial payer audits
Log, compile, and submit Medicare and Medicaid audit request and responses
Effectively communicate with all Medicare and Medicaid auditing entities and personnel
Meet all audit response deadlines
Effectively communicate with physicians' offices
Identify positive and negative audit trends and results (trends)
Work closely and effectively communicate with each profit centers' team lead, captain, and director regarding audit requirements and necessary changes based on audit trends
Recruit/provide and facilitate education and training to profit centers
Log, coordinate, and respond to Medicare patient complaints
Log, coordinate, and submit responses to commercial payer audit requests
Utilize Medicare websites to identify pertinent webinars, guidelines, news, and use same for education
Attend webinars and actively pursue becoming Compliance Certified
Knowledgeable about Medicare guidelines/processes
Medical billing experience with the ability to comprehend remittance advice
Exceptional interpersonal, verbal, and written communication skills
Good working ability with Excel or Google sheets
Gcci Project Specialist For Outcomes, Evaluation And Communications
Kenjya-Trusant is seeking a candidate to fill the role of a GCCI Project Specialist to support the Office of Global Change (EGC), within the State Department’s Bureau of Oceans, Environment and Science (OES).
Clearance - Secret Must be active at time of application
Outcomes and Evaluation (55%)
- Supports compliance with often evolving Department and Bureau processes, policies and procedures at all stages of the funded program from project development to reporting to closeout and evaluation.
- Supports and ensures program compliance with the Department’s Evaluation Policy including leading others in the development of scopes of work for evaluation and working with the Bureau Evaluation Coordinator to ensure the timing and selection of any necessary, annual evaluations;
- Assist in leading the annual Performance Plan and Report process relative to the collection of data for outcome indicators, reporting of results, setting of targets and deviation narratives, obtains all necessary clearances, and provides timely submission to the OES Bureau lead;
- Works within the interagency process (e.g. Bureau of Foreign Affairs) and interagency (e.g. USAID) to ensure appropriate climate change updates to outcome indicators and their definitions and supports greater EGC and recipient understanding of current or changing outcome indicators and their definitions;
- Implements current policy, tracks the development of any policy changes to support EGC compliance with current and evolving evaluation, outcome or reporting policies;
- Supports the integration of climate change standard and custom outcome indicators into a wide range of agreement, including multilateral agreements to support the tracking and collection of outcomes relative to any climate change funding;
- Assist in leading the Data Quality Assessment process, including recommending approaches for timely completion of the DQA process, and including developing written, on-line or inperson assessments and surveys, in keeping with Department standards, of recipients’ data systems to underpin quality data reporting;
- Supports a policy-based management approach, for a limited set of climate change projects that may consist of grants, interagency agreements, transfers or contributions designed to contribute to the realization of the U.S. Government’s climate objectives. Specifically, the Project Manager contractor will perform those project management functions that are not inherently governmental while supporting EGC Technical Leads in assuming those functions that are inherently governmental relative a wide range of project monitoring functions. Activities may involve multiple international and domestic private and public organizations, DoS and other federal and foreign government implementing funded programs for the Office of Global Change.
- Monitor project implementation and performance, including the performance of site visits and the collection, tracking and validation of outcome indicator results. Identify risks to the U.S. of program failures, partial successes and unwanted side effects.
- Research, collect, produce written reviews and analyze pertinent data on project performance and outcomes.
- Keep project records and files for funded projects in keeping with program, Bureau and Department standards;
- Collaborate with the recipients of relevant funded programs including federal agencies, public international organizations, other grant recipients and partners to ensure, once funds are obligated, that activities are performed in a timely manner and, to the extent practicable, performance targets are met and project activities are documented as to their results and impact. In this role, also advises on implementation, especially financial and performance, as well as the evaluation, of all assigned climate projects, identifying issues and proposing improvements where such are deemed necessary and enabling early identification of management issues while allowing for improvement in project performance and direction for future planning;
- Support the development, procurement and tracking of project activities from the Congressional Notifications (CNs) stage to the obligation of funds;
- Support the GOR or AOR in drafting project closeouts and final performance reviews for grants and interagency agreements;
- Supports the annual Congressional notification of any appropriated funding, as requested;
- Supports the development of Hill communications and summarizes information to clearly articulate and share the evolution, implementation and outcomes of the GCCI program;
- Supports program team communications, outcomes, photolog, etc. by supporting functional databases for the project portfolio and tracking compliance that are updated routinely and provide summative data for use in internal and external communications about the breadth and depth of the outcomes of the funded program.
- Supports semi-annual program team reporting reminders with regard to outcome indicators and the data collection strategy for high quality outcome indicators;
- Develops the annual FactBook, including the development of graphs, tables, charts and text, and accuracy thereof, to highlight the administrative breadth and depth of the program and project activities;
- To fulfill the duties and responsibilities of the position, the contractor should have the following skills and background
- MA (social sciences, environment, business or other relevant field);
- Minimum 3-5 years of relevant experience in one or more professional disciplines directly relevant to the duties and responsibilities of the position; Experience monitoring outcomes and engaged in evaluation activities;
- Proven ability to identify, network, and strategically engage with diverse groups;
- Excellent teamwork and time management skills; results-orientation and ability to work under pressure; Advanced skills in Excel or other data management programs; Ability to think both strategically and practically
- Ability to work well and initiate projects independently.
- Knowledge of grants and interagency agreement principles, policies and business processes.
- Knowledge of laws, rules, policies, and regulations regarding grants and interagency agreement administration.
- Ability to apply basic procurement processes, rules, regulations, principles and procedures.
- Ability to analyze, interpret and apply procurement regulations and principles.
- Ability to monitor grants, Interagency Acquisition Agreements and cooperative agreements.
- Ability to work as a team member as well as independently.
- Excellent interpersonal and oral communication skills.
Prevention Research And Evaluation Manager (Bhr)
Prevention Research and Evaluation Manager
WMS Band 2
Are you passionate about research and utilizing epidemiological methods and advanced biostatistical analysis to inform policy decisions in the public children and youth behavioral health system?
Do you have experience in a service setting, reporting out to varied audiences?
If you pride yourself on successfully managing, coordinating and collecting complex health-related data, this opportunity may be for you!
The Prevention Research and Evaluation Manager is responsible to manage data and research related to substance abuse prevention and mental health promotion, to support statewide policy, program, and budget decisions for the Substance Use Disorder Prevention and Mental Health Promotion Unit. This position leads and directs research for the SUD Prevention and MH Promotion Section. This position uses epidemiological methods and advanced biostatistical analysis to: describe the occurrence and distribution of behavioral health morbidity across subpopulations of interest; investigate the causes and consequences of these disorders in order to develop more effective prevention strategies; and promote behavioral health in children, youth, and families.
This position is responsible for providing comprehensive epidemiological research and support for the programming, service delivery, and policy decisions of the SUD Prevention and MH Promotion Section. This includes planning, coordinating, conducting, analyzing, interpreting, and reporting the findings of advanced research investigations that inform service integrity, quality, and cross-system coordination related to intervention development in the public children and youth behavioral health system. Ongoing projects include: research, program evaluation, and quality management for the prevention surveillance data determining and coordinating appropriate preventative measures based on findings; developing, implementing, and improving methods for collecting and using relevant behavioral health data.
The Prevention Research and Evaluation Manager reports directly to the Supervisor for the Substance Use Disorder Prevention and Mental Health Promotion Section.
The main purpose of this position is to manage data and research related to substance use prevention and mental health promotion, to support statewide policy, program, and budget decisions. This position designs and manages descriptive epidemiological profiles needed to support statewide and local data-driven program and policy planning for Substance Use Prevention & Mental Health Promotion. Existing epidemiological data reside in multiple large archival, administrative, and survey databases housed in several state agencies.
Some of what you will do:
Analyze and interpret statewide substance use and mental health indicators to identify the incidence and prevalence of substance use and mental illness, as well as their risk factors.
Analyze data and generate tabulated results for agency management, programs, and other key stakeholders in the state.
Manage creation of the statewide substance use & mental health needs assessment to inform the SPE Policy Consortium's Strategic Plan.
Select and use an appropriate analytic approach from a wide range of descriptive and inferential statistical procedures, such as multiple or logistic regression, trend analysis, multilevel models, post hoc weighting, or other advanced statistical techniques to analyze data.
Analyze data on risk factors, substance use, and mental health, from surveys such as the Healthy Youth Survey and the Young Adult Health Survey, and from prevention administrative data related to services and environmental risk factors, and other related data sources, to inform statewide policy & program decisions.
Investigate new and emerging data sources and develop new indicators to expand capacity for providing program support, for tracking state agency performance measures, and for the inter-agency SPE Policy Consortium's Strategic Plan.
Provide expert consultation to agency management and programs on statewide epidemiological data as well as research and evaluation strategies for the agency's substance use prevention and mental health promotion services.
Participate in the development, management, and analysis of surveys and other data collection efforts.
Participate in development of questions and proposals for existing state-sponsored surveys, recommending current best-practices and scientific evidence.
Develop reports, disseminate findings and implement statewide communication strategies related to the relevant data & research activities. Provide expert consultation and develop and deliver trainings on these data & reports.
Provide data analysis and reporting on health disparities to inform agency managers for decision making.
Manage and administer statewide projects related to research and evaluation.
Here is what we are looking for (Required Qualifications):
Master's degree in a social science or statistics from an accredited university, with significant coursework and training in research methodology and data governance and two years of experience in a service setting with data definitions, data collection, analysis, and reporting of results in terms a layperson can understand, or a Bachelor's degree and five years of experience.
Three years of direct experience managing, coordinating and collecting health-related data for complex health systems. Work experience must include successful performance at an increasingly challenging and accountable level.
Experience with statistical analysis and principles of biostatistics.
Training in the principles of epidemiology, and two or more years of experience conducting applied epidemiological research.
Three years of SAS, SPSS or equivalent programming and statistical analysis experience and ability to attain proficiency of Agency preferred software within 1 year from hire. Work experience must include successful performance at increasingly challenging statistical analysis including programming queries, generating data, and preparing reports.
Three years of experience in a service setting with data definitions, data collection, analysis, and reporting out results in terms a layperson can understand. Work experience must include successful performance at an increasingly challenging and accountable level.
Experience in public health, prevention programs and research or related social science fields.
Demonstrated ability to effectively lead multidisciplinary work teams and manage data-related information projects including ability to work cooperatively with managers and staff to achieve organizational mission and vision; ability to communicate and comprehend (via oral and written forms) with management, peers, clients, and the public in a professional and respectful manner.
Strong communication skills including, demonstrated ability to report results in terms a layperson can understand; working in groups, and translating research to practice
How to Apply:
Only candidates who reflect the minimum qualifications on their NEOGOV profile will be considered. Failure to follow the application instructions below may lead to disqualification. To apply for this position you will need to complete your profile and attach:
A cover letter that specifically addresses how you meet the qualifications for this position.
Three professional references including at least one past supervisor.
If you have questions about the process, or need reasonable accommodation, please contact the recruiter before the posting closes. The candidate pool certified for this recruitment may be used to fill future similar vacancies for up to the next six months.
Washington State is an equal opportunity employer. Persons with disabilities needing assistance in the application process, or those needing this job announcement in an alternative format may call the Human Resources Office at 360.725.1180 or email Sanyu.Tushabe@hca.wa.gov.
- Prior to a new hire, a background check including criminal record history will be conducted. Information from the background check will not necessarily preclude employment but will be considered in determining the applicant's suitability and competence to perform in the position. *
Complaint & Appeal Anly
Responsible for managing to resolution Pre Service appeal scenarios for all products, which may contain multiple issues and, may require coordination of responses from multiple business units. Ensure timely, customer focused response to appeal requests. Identify trends and emerging issues and report and recommend solutions.
In the position, the following functions will be performed:
Review of contract materials to determine if coverage criteria met.
Interpret Medicare Regulations
- Draft letters to members in a clear and concise manner.
Update internal system, documenting the activity of case file review with clarity and accuracy.
Maintain accountability for resolving each case within established timeframes.
Recognize trends and provide solutions.
4-6 years Medicare experience is a plus.
Candidate should have claims knowledge to include the ability to navigate through the claims systems.
Must resolve each and every case in accord with the regulatory time frames.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Medical Management/Medical Management
Legislative and regulatory compliance/1-3 Years
Medical Management/Medical Management
Network Management/1-3 Years
Medical Management/Medical Management
Medical Management/Medical Management
Complaints, Grievance & Appeals/4-6 Years
- Mainframe Tools and Software/TE Rumba/1-3 Years/End User
- Desktop Tools/Microsoft Word/4-6 Years/End User
- Aetna Applications/Automated Claim Adjudication System/4-6 Years/End User
- Aetna Applications/Aetna Document Search/4-6 Years/End User
Leadership/Collaborating for Results/ADVANCED
Leadership/Driving a Culture of Compliance/ADVANCED
Service/Providing Solutions to Constituent Needs/FOUNDATION
Benefits Management/Interacting with Medical Professionals/ADVANCED
General Business/Communicating for Impact/ADVANCED
General Business/Maximizing Work Practices/ADVANCED
ADDITIONAL JOB INFORMATION
Must have the ability to exemplify Aetna values in daily work, promote collaborative relationships with others and foster a sense of teamwork with internal/external constituents which includes regular interaction with medical providers, peers, Medicare members, regulatory agencies and the management team. Must be able to multi-task in a fast paced environment. Must remain flexible with the ability to adapt to change in the work environment and perform assigned tasks with accuracy. Must be able to adjust to regulatory, departmental and workflow changes. Must have the skill set to communicate and draft correspondence to internal/external constituents in a clear and concise manner. Must have the ability to adhere to strict regulatory timeframes and meet established metrics. Must maintain focus on producing high quality work and resolving cases in a timely fashion. Organization skills are essential and a tool used to maintain compliance with individual inventory assignment. Medicare knowledge is a plus.
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna takes our candidates's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.
Senior Complaint Resolution Officer (6061U) #26112
The University of California, Berkeley, is one of the world's most iconic teaching and research institutions. Since 1868, Berkeley has fueled a perpetual renaissance, generating unparalleled intellectual, economic and social value in California, the United States and the world. Berkeley's culture of openness, freedom and acceptance—academic and artistic, political and cultural—make it a very special place for students, faculty and staff.
Berkeley is committed to hiring and developing staff who want to work in a high performing culture that supports the outstanding work of our faculty and students. In deciding whether to apply for a staff position at Berkeley, candidates are strongly encouraged to consider the alignment of the Berkeley Workplace Culture with their potential for success at http://jobs.berkeley.edu/why-berkeley.html.
UC Berkeley is committed to creating and maintaining a community dedicated to the advancement, application and transmission of knowledge and creative endeavors through academic excellence, where all individuals who participate in University programs and activities can work and learn together in an atmosphere free of discrimination, harassment, exploitation, or intimidation.
The Office for the Prevention of Harassment and Discrimination (OPHD) is responsible for ensuring the University provides an environment for faculty, staff, and students that is free from discrimination, harassment, and sexual violence. OPHD takes reports alleging discrimination and harassment on the basis of categories including race, color, national origin, gender, age, sexual orientation/identity, including allegations of sexual harassment and sexual violence.
The Complaint Resolution Officer, Office for the Prevention of Harassment and Discrimination (OPHD) is responsible for ensuring the University provides an environment for students, faculty and staff that is free from discrimination, harassment and hostile environments based protected categories outlined in state, federal and university nondiscrimination statutes and policies, including sex, gender, sexual orientation/identity, race, color, national origin, religion, age etc. The Complaint Resolution Officer is responsible for implementing the UC Policy on Sexual Violence and Sexual Harassment and Complaint Resolution Procedures for faculty, staff and students, the UC Nondiscrimination Policies applicable for faculty, staff and students, the campus and the Berkeley campus Policy on Conflicts of Interest Arising Out of Consensual Relationships.
Conduct highly confidential investigation involving UCB faculty, staff,, students, other community members and applicants; produce summary of findings reports of complaints brought forward by the above-mentioned populations under the UC Sexual Violence and Sexual Harassment Policy and other applicable nondiscrimination policies. Make findings and recommendations for appropriate discipline, sanctions and programmatic responses from department administration, according to established policies and procedures. Consult with adjudication review bodies, Chancellor's designate reviewers, and participate in disciplinary hearing processes as appropriate. Act as a liaison in joint investigations with other location resources. Participate in litigation processes as appropriate, e.g., consultations with litigation defense teams and deposition or court testimony.
Make high-level contacts of a sensitive nature, internally and externally requiring discretion and diplomacy. This position's caseload focuses on the most technically and complex and politically sensitive matters, such as those involving one or a number of the following factors: respondents who are ladder rank faculty, senior level administrators, or athletic coaches; egregious, potentially criminal conduct; concurrent law enforcement investigation; and concurrent or likely litigation.
In addition to conducting and providing guidance on investigations, determine the need or opportunity for alternative resolution strategies to resolve complaints of discrimination and harassment. These cases involve the same experience and judgment with regard to risk management, expert knowledge of applicable policies and laws, attention to detailed communication and documentation, and expert communication skills as that required for formal investigations with policy findings. Alternative resolutions are often delicate and complex processes requiring careful planning and monitoring. Implements courses of action according to established policies and procedures.
Supporting the Deputy Title IX Officer,, provide ad hoc guidance to OPHD complaint resolution officers on complex, challenging issues that arise during their case resolutions.
Assist the OPHD Title IX Officer and Deputy Title IX Officer in the response to external reviews and audits from external civil rights agencies, e.g., the Dept. of Education's Office for Civil Rights and the Office of Federal Contract Compliance Programs, EEOC and California's DFEH, as well as other federal and state agencies, e.g., NASA, DOE, NSF, etc.
Assist Title IX Officer and Deputy Title IX Officer in Title IX-related consultation and monitory of Title IX and NCAA gender equity compliance programs, as well as training and briefing for Intercollegiate Athletics and Recreational Sports management.
Research best practices in one or more nondiscrimination areas, develop in-service education.
Collaborate with campus partners in campus education programs focusing on SVSH response and prevention.
Develop subject matter content for website and other OPHD communications.
Make recommendations to the Title IX Officer and Deputy Title IX Officer regarding the development and implementation of critical coordinated response systems.
Lead or participate in campus committees and workgroups as needed to address policy issues, complaint response systems, and educational programs.
Keep abreast of best practices in advanced investigation techniques. Participate in professional development to maintain and enhance technical and subject matter expertise.
Minimum 5 of years' experience in conducting complex workplace and/or student investigations. Experience conducting sensitive interviews with complainants, respondents and witnesses in cases with emotionally charged fact patterns.
Thorough knowledge of higher education processes, protocols and procedures or experience with a similarly complex organization.
Intermediate to advanced knowledge of common campus-specific computer applications.
Advanced analytical/problem-solving skills.
Advanced communication and interpersonal skills to communicate effectively with all levels of staff and influence, both verbally and in writing.
Demonstrated ability to present investigation findings and make recommendations in a clear, concise manner both in writing and verbally, to peers, unit supervisors and campus leaders.
Ability to apply appropriate policies and practices in the completion of ethics and compliance assignments. Skills in critical decision making.
Ability to multi-task with demanding timeframes.
Proven ability to use discretion and maintain confidentiality.
Broad and advanced knowledge in the following areas: campus or organizational Title IX policies and procedures; nondiscrimination policies; relevant employment policies and disciplinary procedures for staff or academic employees, and/or students; applicable federal and state regulations and guidance in a large higher education environment or comparable-sized organization.
In-depth abilities in collaboration, facilitation, and strategic and creative thinking.
Thorough understanding of the interrelationship of procedures and desired results.
Excellent interpersonal and problem-solving skills to work independently with all levels of University personnel, including management and faculty, and to facilitate agreement on issues and corrective actions.
Bachelor's degree in related area and/or equivalent experience/training.
Title IX compliance certification.
Training in trauma-focused approaches to investigation.
Salary & Benefits
For information on the comprehensive benefits package offered by the University visit:
How to Apply
Please submit your cover letter and resume as a single attachment when applying.
Conviction History Background
This is a designated position requiring fingerprinting and a background check due to the nature of the job responsibilities. Berkeley does hire people with conviction histories and reviews information received in the context of the job responsibilities. The University reserves the right to make employment contingent upon successful completion of the background check.
This position has been identified as a Mandated Reporter required to report the observed or suspected abuse or neglect of children, dependent adults, or elders to designated law enforcement or social service agencies. We reserve the right to make employment contingent upon completion of signed statements acknowledging the responsibilities of a Mandated Reporter.
Equal Employment Opportunity
The University of California is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. For more information about your rights as an applicant see: http://www.eeoc.gov/employers/upload/poster_screen_reader_optimized.pdf
For the complete University of California nondiscrimination and affirmative action policy see:
Software Assurance Evaluation Engineer Level 3
The Level 3 Software Assurance Evaluation Engineer shall be able to perform the following:
- Capable of surveying industry to identify new source code SwA tools and methodologies.
- Tuning and running source code analysis tools, evaluating the strengths and weaknesses and determining the suitability for a given software/customer.
- Designing and testing source code SwA analysis processes.
- Interpreting, prioritizing and using source code SwA tools results to remediate potential vulnerabilities in software.
- Developing software using structure development environments (i.e. Waterfall, Agile).
- Writing code in Java, C, C++, or C#.
- Creating and presenting technical briefings.
TS clearance required
Gcci Project Specialist For Outcomes, Evaluation And Communications
Kenjya-Trusant is seeking a candidate to fill the role of a GCCI Project Specialist to support the Office of Global Change (EGC), within the State Department's Bureau of Oceans, Environment and Science (OES).
Clearance - Secret Must be active at time of application
Outcomes and Evaluation (55%)
Supports compliance with often evolving Department and Bureau processes, policies and procedures at all stages of the funded program from project development to reporting to closeout and evaluation.
Supports and ensures program compliance with the Department's Evaluation Policy including leading others in the development of scopes of work for evaluation and working with the Bureau Evaluation Coordinator to ensure the timing and selection of any necessary, annual evaluations;
Assist in leading the annual Performance Plan and Report process relative to the collection of data for outcome indicators, reporting of results, setting of targets and deviation narratives, obtains all necessary clearances, and provides timely submission to the OES Bureau lead;
Works within the interagency process (e.g. Bureau of Foreign Affairs) and interagency (e.g. USAID) to ensure appropriate climate change updates to outcome indicators and their definitions and supports greater EGC and recipient understanding of current or changing outcome indicators and their definitions;
Implements current policy, tracks the development of any policy changes to support EGC compliance with current and evolving evaluation, outcome or reporting policies;
Supports the integration of climate change standard and custom outcome indicators into a wide range of agreement, including multilateral agreements to support the tracking and collection of outcomes relative to any climate change funding;
Assist in leading the Data Quality Assessment process, including recommending approaches for timely completion of the DQA process, and including developing written, on-line or inperson assessments and surveys, in keeping with Department standards, of recipients' data systems to underpin quality data reporting;
Project Management (25%)
Supports a policy-based management approach, for a limited set of climate change projects that may consist of grants, interagency agreements, transfers or contributions designed to contribute to the realization of the U.S. Government's climate objectives. Specifically, the Project Manager contractor will perform those project management functions that are not inherently governmental while supporting EGC Technical Leads in assuming those functions that are inherently governmental relative a wide range of project monitoring functions. Activities may involve multiple international and domestic private and public organizations, DoS and other federal and foreign government implementing funded programs for the Office of Global Change.
Monitor project implementation and performance, including the performance of site visits and the collection, tracking and validation of outcome indicator results. Identify risks to the U.S. of program failures, partial successes and unwanted side effects.
Research, collect, produce written reviews and analyze pertinent data on project performance and outcomes.
Keep project records and files for funded projects in keeping with program, Bureau and Department standards;
Collaborate with the recipients of relevant funded programs including federal agencies, public international organizations, other grant recipients and partners to ensure, once funds are obligated, that activities are performed in a timely manner and, to the extent practicable, performance targets are met and project activities are documented as to their results and impact. In this role, also advises on implementation, especially financial and performance, as well as the evaluation, of all assigned climate projects, identifying issues and proposing improvements where such are deemed necessary and enabling early identification of management issues while allowing for improvement in project performance and direction for future planning;
Support the development, procurement and tracking of project activities from the Congressional Notifications (CNs) stage to the obligation of funds;
Support the GOR or AOR in drafting project closeouts and final performance reviews for grants and interagency agreements;
Communications, CN and Reporting (20%)
Supports the annual Congressional notification of any appropriated funding, as requested;
Supports the development of Hill communications and summarizes information to clearly articulate and share the evolution, implementation and outcomes of the GCCI program;
Supports program team communications, outcomes, photolog, etc. by supporting functional databases for the project portfolio and tracking compliance that are updated routinely and provide summative data for use in internal and external communications about the breadth and depth of the outcomes of the funded program.
Supports semi-annual program team reporting reminders with regard to outcome indicators and the data collection strategy for high quality outcome indicators;
Develops the annual FactBook, including the development of graphs, tables, charts and text, and accuracy thereof, to highlight the administrative breadth and depth of the program and project activities;
To fulfill the duties and responsibilities of the position, the contractor should have the following skills and background
MA (social sciences, environment, business or other relevant field);
Minimum 3-5 years of relevant experience in one or more professional disciplines directly relevant to the duties and responsibilities of the position; Experience monitoring outcomes and engaged in evaluation activities;
Proven ability to identify, network, and strategically engage with diverse groups;
Excellent teamwork and time management skills; results-orientation and ability to work under pressure; Advanced skills in Excel or other data management programs; Ability to think both strategically and practically
Ability to work well and initiate projects independently.
Knowledge of grants and interagency agreement principles, policies and business processes.
Knowledge of laws, rules, policies, and regulations regarding grants and interagency agreement administration.
Ability to apply basic procurement processes, rules, regulations, principles and procedures.
Ability to analyze, interpret and apply procurement regulations and principles.
Ability to monitor grants, Interagency Acquisition Agreements and cooperative agreements.
Ability to work as a team member as well as independently.
Excellent interpersonal and oral communication skills.
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