w3r Consulting

Role Description This position is responsible for identifying, analyzing, and evaluating requirements for implementation; developing written test plans and test cases from requirements document; executing testing criteria, analyzing test output; documenting work plans for assignments; reporting and communicating issues/discrepancies and recommending solutions; assisting in defining a systematic approach to solving issues; knowledge of cross team functionality; representing team outside of the department; working independently within employees assigned area; links both technical and business requirements in their associated area of expertise; and proactively searches out potential problems, and recommends resolutions. In this role the Testing Analyst will be responsible for Medicare plan data validation testing for our external partner platforms: - Reviewing Medicare plan benefits, rate testing, and Provider Data to support accuracy of our Medicare product lines within multiple quote and enrollment platforms. - Track/Log test cases to report defects for resolution. - Testing is manually tracked and manually reviewed for accurate benefits such as Co-pays, Coinsurance, Deductibles, etc. across multiple platforms. - Responsible for developing test case sheet, capturing issues and identifying trends to report to the team. Qualifications - Inquisitive and detail oriented, must ask the why and how. - Self-starter, independently driven and motivated. - Apply analytical skills and utilize research techniques, problem solving and resolution skills. - Clear and concise verbal, written and interpersonal skills including the ability to work with teams. - Complete projects in a timely manner. - PC experience to include Microsoft Access, Word. Requirements - Bachelor degree. - Experience in testing and researching claim adjudication problems. - Experience with technical applications such as SQL, Access, Excel other database, design, structure and manipulation product. - Knowledge of the developmental life cycle. - Knowledge of JIRA or RTC. - Working knowledge of client's systems and HCM business operations. - Health Insurance industry knowledge. - Training technical information to groups. - Technical writing skills (training manuals, matrices, etc).

Role Description To perform standardized end-to-end SDAC administration and coordination functions to ensure ongoing agent and agency (internal and external) compliance requirements are met. - Manage, process, and document cases for the Sales Development Action Program and committees. - Research potential application issues related to application timeliness for agents. - Use analytical skills and individual judgement to determine if a violation occurred. - Generate and analyze individual reports to make recommendations and future actions. - Research past history of agents and apply personal judgment regarding re-contracting risks. - Ensure timely reinstatements to support rapid growth models set by the Sales Department. - Work independently on complex issues and provide resolutions regarding training and remediation for agent violations. - Accountable for ensuring all steps of each SDAP case are covered. - Send correspondence to agents and agencies regarding SDAC cases and training. - Serve as a liaison between SDAC Committee and internal/external partners. - Proactively communicate with partners to facilitate the SDAP process. - Demonstrate the value that HealthSpring brings to the market. - Act as a subject matter expert for SDAP or Sales Integrity related issues. - Support program development and provide technical advice on regulatory issues. - Perform training with agents and sales representatives to close SDAC cases. - Maintain knowledge of State, Federal, and HealthSpring rules and regulations. - Perform quality checks to ensure compliance with CMS and HealthSpring policies. - Act as a technical resource, coach, trainer, and mentor to team members. - Perform ad hoc audits and projects outside of normal duties. - Negotiate or resolve complex issues with customers and partners. - Coordinate data compilation requests and document maintenance projects. - Be honest and respectful in all dealings with partners. Qualifications - Three to five years of experience in Medicare Advantage. - Bachelor's degree or equivalent work experience. - Knowledge of CMS and HealthSpring compliance policies and procedures. - High attention to detail, quality, and accuracy. - Strong coordination and organizational skills. - Ability to communicate effectively and follow-up where needed. - Fast-learner and multi-tasking skills. - Ability to work independently in a matrixed environment. - Strong interpersonal and prioritization skills. - Sales and/or training experience recommended. - Strong written and verbal communication skills required. - Ability to handle multiple assignments, projects, and deliverables simultaneously required. - Ability to work under pressure and flexible hours required. Requirements - Competencies: Informing, Organizing, Priority Setting, Perseverance, Problem solving, Customer Focus, Organizational Agility, Interpersonal Savvy. - Ensure familiarity and expertise in HealthSpring systems including Microsoft Office, CRM, and SharePoint.

Role Description Government Programs Care Manager III. For this position, formerly Nurse Case Management Senior Analyst, through the care management process, will promote the improvement of health outcomes to SNP members. Also assist those members experiencing the burdens of illness and injury. The Care Manager will assess, plan, implement, coordinate, monitor and evaluate options and services to meet an individual's health needs within case load assignments of a defined population. The Care Manager will promote quality cost-effective outcomes managing care needs through the continuum of care utilizing effective verbal and written communication skills and a consumerism approach through education and health advocacy to members serviced. Ability to work independently and effectively communicate to internal and external customers in a telephonic environment. Responsibilities - Establishes a collaborative relationship with client (plan participant/member), family, physician(s), and other providers to determine medical history, current health status, and assess the options for optimal outcomes. - Promote consumerism through education and health advocacy. - Assesses members health status and treatment plan and identifies any gaps or barriers to healthcare. - Establishes a documented patient centric care management plan involving all appropriate parties (client, physician, providers, employers, etc), identifies anticipated case results/outcomes, criteria for case closure, and promotes communication within all parties involved. - Implements, coordinates, monitor and evaluate the care management plan on an ongoing, appropriate basis. - Adheres to professional practice within scope of licensure and certification quality assurance standards and all care management policy and procedures. - Participates in unit and corporate training initiatives and demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate. - Demonstrates sensitivity to culturally diverse situations, clients and customers. - All care management activities and performance metrics are monitored. - 40 hour schedule that supports M-F, 8 working hours each work day (exclusion of company holidays). Qualifications - Active unrestricted Registered Nurse (RN) license in state or territory of the United States. - Compact RN license a required for this role. - Two years full-time equivalent of direct clinical care to the consumer.

Role Description Under broad direction, responsible for overseeing the following functional areas: - Technology - Major systems (e.g., process simulation, document management, payroll, etc.) Responsible for the development/acquisition, maintenance, and/or support of applications in that area. Influence the assignment of personnel to various activities and provide performance feedback. - Leads and participates in the preparation of all requirements/specifications, estimates, system designs, and completed systems. - Ensures that quality support is provided to customers and clients. - Often involves performing project setups, analyses, designs, etc., for/with customers. - Researches and makes recommendations on software technology direction. Prepare activity and progress reports for management and enforce compliance with administrative policies and procedures. Qualifications - Undergraduate degree in computer science (CS), management information systems (MIS), bachelor of arts (A), or Engineering. - 8 years of experience in Systems Development and/or Applications Support. Requirements - Hands-on operational role responsible for day-to-day deployment, administration, security integration, and governance of client Claude Enterprise tenant. Benefits - Claude Enterprise Administration - SAS Security - Platform Usage Analytics and Reporting - ChatGPT Enterprise Administration