New Career Bootcamp

The Cure for Career Confusion

  • Career Clarity Coaching
    • First Coaching Session Preparation
    • New Client Orientation & Welcome Document
    • Research Job & Career Ideas
      • Job Idea Evaluation Workbook
      • 100 – Overview of Job & Career Idea Research
      • 110 – How to Use the Job Search Profiles
      • 120 – How To Research Job & Career Ideas (Initial Strategies)
      • 140 – Salary Research Tools
      • 150 – Explore Industry Ideas
      • 160 – Research Other Peoples’ Career Transitions to Job Titles that Appeal to You
      • 170 – How to Research Job Titles at Companies that Appeal to You
      • 180 – Informational Interviews
    • How to Choose the Right New Career
      • Create a Career Vision Summary
      • Reduce Dimensionality
      • Don’t Trust Your Gut (Without Testing It)
      • Beware of the Giant Spreadsheet
      • Attain Distance
      • Conduct a Risk Analysis
      • Integrated Thinking
      • Accept Uncertainty
      • Ikigai Career Map
      • Marshall Goldsmith Strategy to Evaluate Job & Career Ideas
    • Do You Need To Be Passionate About Your Job?
    • Training Programs for Technology Jobs & Careers
    • Resumes, Job Search, Interviewing & More
  • Quick Question Coaching
  • Job Search Breakthrough
    • Job Search Strategies Overview
    • Weekly Job-Search Campaign Tools & Planner
    • How Long Will It Take You To Land A New Job?
    • Agency Recruiters
      • How to Find Recruiters in Your Target Niche
    • Enhance Your Job Search with LinkedIn’s Home Page
    • The Simple Social Media Job Search Strategy
  • Online Job Search
    • Module 1: Introduction & Overview
    • Module 2: Top Strategies To Find Relevant, Advertised Job Openings
      • (2.1 – Part 1) Use The Best Job Boards To Find Advertised Job Openings
      • (2.1 – Part 2) Best Startup Job Boards
      • (2.3) Clever Way To Use LinkedIn To Find Appealing Companies That Might Have Job Boards
      • (2.4) How To Set Up Job Search Alerts To Stop Wasting Your Time
      • (2.5) Is It A Waste Of Time To Apply If You’re Not Perfectly Qualified?
      • (2.6) What is the Best Time to Submit Your Application Online?
      • (2.7) How Many Jobs a Week Should You Apply to?
      • (2.8) Should You Post Your Resume on Job Boards?
    • Module 3: Tips & Tricks For Submitting Your Resume & Cover Letter For More Success
      • (3.1) 4 Ways To Quickly Tailor Your Resume To Win More Interviews
      • (3.2.1) Write A Blockbuster Cover Letter That Positions You For A Career Change
      • (3.2.2) Handling Salary Info in a Cover Letter
      • (3.3) Best Practices For Submitting Your Resume & Cover Letter
      • (3.3.1) What to do if You’re Applying Online and There’s a Salary Box
      • (3.4) Should You Follow Up With Human Resources?
    • Module 4: Get Insider Help To Win Job Interviews
      • (4.1) Why Company Employees Will Help You (Even If They Don’t Know You)
      • (4.2) How To Find Helpful Company Insiders To Maximize Your Success
      • (4.3) Unknown Ways To Use LinkedIn To Find Helpful Insiders
      • (4.4) How To Choose The Best Company Insiders To Talk To
      • (4.5) The Most Effective Ways To Contact Company Insiders You Don’t Know
      • (4.6) Do This To Ensure A Successful Conversation With Company Insiders
      • (4.7) Best Questions To Ask Company Insiders To Get The Information & Help You Want
      • (4.8) Steal These Sample Thank You Notes
    • Module 5: Fly by HR & Get to the Real Decision Maker
      • (5.1) Identify the REAL Decision Maker
      • (5.2) Access Nearly Any Hiring Manager’s LinkedIn Profile
      • (5.3) Get Nearly Any Hiring Manager’s Contact Information
      • (5.4) The Interview Magnet Letter Formula
      • (5.5) Interview Magnet Samples
      • (5.6) Get Your Interview Magnet Letter Into The Hands of the Hiring Manager
    • Implementation Coaching
  • Hidden Job Search
    • Module 1: Welcome to Hidden Job Search Breakthrough!
      • (1.1) Why You Must Search for Unadvertised Job Openings
      • (1.3) Mindset For Success
    • Module 2: Hidden Job Search Strategy Overview
      • (2.1) Super Strategy Overview
      • (2.2) Action Steps & Program Table of Contents
      • (2.3) Discover The Two Types of Hidden Job Searches
    • Module 3: Identify Many Companies That Could Hire You
      • (3.1) Define Your Target Market
      • (3.2) How Many Potential Employers Is Enough?
      • (3.3) The Best Ways to Build A List Of Potential Employers
      • (3.5) Job Search Organization
      • (3.6) Classify Potential Employers
    • Module 4: The “Customized” Strategy
      • (4.1) Select The Best Companies To Target
      • (4.2) How To Easily Identify Hiring Managers And Insider Connections
      • (4.3) Best Research Strategies To Win More Job Interviews
      • (4.4) How To Use Informational Interviews To Increase Your Success
      • (4.5) Top Strategies To Comfortably Contact Hiring Managers
      • (4.6) Discover How To ‘Keep In Touch’ So Hiring Managers Yearn For You
    • Module 5: The “Universal” Strategy
      • (5.1) Select Potential Employers To Target
      • (5.2) Top Strategies To Easily Identify People Who Might Want To Hire You Today
      • (5.3) The Universal Job Magnet Letter Formula (With Samples)
      • (5.4) Best Ways To Quickly And Easily Contact People Who Can Hire You
    • Module 6: Best Ways To Find People Who Can Hire You… Or Help You Get A Job
      • (6.1) 6 Quick Ways To Identify People Who Could Hire You
      • (6.2) Best Practices for Using Advanced Searches On LinkedIn To Find People Who Could Hire You
      • (6.3) Unknown Strategies To Find Insider Connections On LinkedIn
      • (6.4) Networking Strategies
      • (6.5) Little Known Strategies To Access Nearly Anyone’s LinkedIn Profile
      • (6.6) Hush Hush Ways To Get Nearly Anyone’s Contact Information Fast
    • Implementation Coaching
  • Job Search Networking
    • Introduction
    • 6 Myths & Facts About Networking
    • Personal Job Search Networking Training Modules
      • Module 1: How to Begin
      • Module 2: Be Effective – Prioritize Your Networking List
      • Module 3: 5 Key Strategies for Success Job Search Networking
      • Module 4: 7 Sample Networking Request Letters
      • Module 5: How to Create Your Elevator Pitch (With Samples)
      • Module 6: Creating Your Personal Marketing Plan
      • Module 7: What to Say (and Avoid) in Networking Conversations
      • Module 8: Sample Thank You Note For Networking Help
      • Module 9: Keep in Touch and the Law of Sevens
      • Module 10: The One+ Strategy
    • Event Networking
      • Find Networking Events Worth Going To
      • Make the Most of Networking Events
    • Networking Business Cards & Samples
  • Interview Breakthrough
    • Welcome to Interview Breakthrough!
    • (1.1) Action Steps and Program Table of Contents
    • Module 2: Mindset for Success
      • (2.1) The Art of Turning Interviews Into Enjoyable Conversations
      • (2.2) The Four Hot Buttons of Every Hiring Manager
      • (2.3) Turn Lemons Into Lemonade
      • (2.4) Dealing with Rejection
    • Module 3: Prepare to Win Job Offers
      • (3.1) Background Research
      • (3.2) What Salary Are You Worth?
      • (3.3) Get Insider Help To Win Offers
        • (3.3.1) Why Company Employees Will Help You (Even If They Don’t Know You)
        • (3.3.2) How To Find Helpful Company Insiders
        • (3.3.3) Use LinkedIn To Find Helpful Insiders
        • (3.3.4) Choose The Best Company Insiders To Talk To
        • (3.3.5) The Most Effective Ways To Contact Company Insiders You Don’t Know
        • (3.3.6) Do This To Ensure A Successful Conversation With Company Insiders
        • (3.3.7) Best Questions To Ask Company Insiders To Get The Information & Help You Want
        • (3.3.8) Sample Thank You Notes
      • (3.4) Make a Strong First Impression
    • Module 4: Get the Salary You Deserve
      • (4.1) Salary Research
      • (4.2) Here’s YOUR Salary Discussion Strategy
      • (4.3) What to Say When They Want to Know Your Salary History & Requirements
        • (4.3.1) Handling Salary Info in a Cover Letter
        • (4.3.2) Handling Online Salary Boxes
        • (4.3.3) Handling Salary Discussion DURING an Interview
    • Module 5: Interview Questions & Answers
      • (5.1) Handle Job Interview Questions With Ease
      • (5.2) Interview Question & Answer Guide
      • (5.3) Prepare for These Potential Interview Questions
      • (5.4) Tell Me About You…
      • (5.5) Questions YOU Can Ask at a Job Interview
    • How to Give a Killer Presentation
    • Module 6: Interview Strategies That Win Job Offers
      • (6.0) Participate (and look good) in Skype Interviews
      • (6.1) Ace Your Phone Interviews
      • (6.2) Align Your Experience With The Position
      • (6.3) Discover What the Interviewer REALLY Wants
      • (6.4) Eliminate the Interviewer’s Doubts About You
      • (6.5) How to Prove You Can Do a Job You Haven’t Done (Webinar)
      • (6.6) Handling Salary Discussions DURING Interviews
      • (6.7) How to Close Your Interview
      • (6.8) Essential Do’s and Dont’s
    • Module 7: Seal the Deal (What to do after the Interview)
      • (7.1) How Did You Do?
      • (7.2) Keep In Touch For More Success
      • (7.3) Send This Instead of A Thank You Note
      • (7.4) 90-Day Plan
      • (7.5) Top Tips for Handling References Professionally During Your Job Search
    • Module 8: Handling Job Offers Successfully
      • (8.1) How to Stall a Job Offer
      • (8.2) Job Offer Evaluation Checklist
      • (8.3) Signs That a Company Is a Bad Apple
      • (8.4) Avoid a Mess – Checkout Your New Boss
      • (8.5) Handling Salary Negotiations
      • (8.6) Should You Let an Executive Recruiter Negotiate Your New Salary?
      • (8.7) Ready to Accept a Job Offer? Read These Documents Carefully First
      • (8.8) Accept a Job Offer the Right Way
      • (8.9) Using an Outside Offer to Get a Raise
    • Module 9: How to Choose the Right Job Offer
      • (9.1) Create a Career Vision Summary
      • (9.2) Reduce Dimensionality
      • (9.3) Don’t Trust Your Gut (Without Testing It)
      • (9.4) Beware of the Giant Spreadsheet
      • (9.5) Attain Distance
      • (9.6) Conduct a Risk Analysis
      • (9.7) Integrated Thinking
      • (9.8) Accept Uncertainty
    • Module 10: Interview Correspondence
      • (10.1) Sample Letter Withdrawing From Consideration
      • (10.2) Sample Letter Accepting a Job Offer
      • (10.3) Sample Letter Declining a Job Offer Because of a Low Salary
      • (10.4) Sample Letter Declining a Job Offer Because You Don’t Want the Job
      • (10.5) Sample Letter to Write When You Don’t Get a Job Offer But You Want a Second Chance at Getting It
      • (10.6) Sample Letters Thanking a Reference
      • (10.7) Sample Job Resignation Letter
    • Implemetation Coaching
  • Gift Certificates
  • Contact

Mediation | Arbitration | Appeals | Grievances

Here sample job advertisements for these types of roles….


HEARING OFFICER

New York City HRA/DEPT OF SOCIAL SERVICES, Manhattan, NY
$65,731 – $75,591 a year

Human Capital Management (HCM)/Office of Disciplinary Affairs (ODA) acts as the principal consultant to managers and supervisors in matters concerning disciplinary issues; the Office of Disciplinary Affairs is recruiting for one (1) Associate Staff Analyst to function as a Hearing Officer who will be responsible for: ? Reviewing supporting documentation of requests for disciplinary charges against DSS/HRA/DHS employees for misconduct or poor performance to determine whether there is enough supporting documentation to proceed with disciplinary action against the employee.? Drafting and preparing formal disciplinary charges based on substantiated requests for disciplinary charges of incompetence, misconduct, poor performance, excessive and unauthorized absences and lateness.? Communicating with representatives from the various program areas to update them on cases they have referred and when necessary, request additional documentation for the cases.? Maintaining communication with union representatives to discuss cases and negotiate settlements.? Writing charges and specifications in legally viable format; drafts letters, memorandums, and other correspondence to communicate or request information needed on a case.? Conducting Step I Hearings on charges by following agency procedures and eliciting pertinent information.? Preparing summary memorandums on penalty recommendations based on findings of fact, supporting documentation, witness statements, and the employee’s testimony at the Step I Hearing.? Confirming that the employee has been served with the charges prior to the date of the Step I Hearing and provides the employee and his/her representative with the proof of service.? Scanning and downloading necessary documents into the TEAMS database concerning assigned cases and filling out all required fields in the TEAMS database concerning assigned sections of the case.? Maintaining assigned case files and adding any additional documents provided during the course of drafting charges or penalty summary for the case.

Minimum Qual Requirements

1. A master?s degree from an accredited college or university, accredited by regional, national, professional or specialized agencies recognized as accrediting bodies by the U.S. Secretary of Education and the Council for Higher Education Accreditation (CHEA) in economics, finance, accounting, business or public administration, human resources management, management science, operations research, organizational behavior, industrial psychology, statistics, personnel administration, labor relations, psychology, sociology, human resources development, political science, urban studies or a closely related field, and one year of satisfactory full-time professional experience in one or a combination of the following: working with the budget of a large public or private concern in budget administration, accounting, economic or financial administration, or fiscal or economic research; or in management or methods analysis, operations research, organizational research or program evaluation; or in personnel or public administration, recruitment, position classification, personnel relations, labor relations, employee benefits, staff development, employment program planning/administration, labor market research, economic planning, social services program planning/evaluation, or fiscal management; or in a related area; or 2. A baccalaureate degree from an accredited college or university, accredited by regional, national, professional or specialized agencies recognized as accrediting bodies by the U.S. Secretary of Education and the Council for Higher Education Accreditation (CHEA) and three years of satisfactory full-time professional experience in the areas described in ?1″ above.

Additional Information

LOAN FORGIVENESSThe federal government provides student loan forgiveness through its Public Service Loan Forgiveness Program (PSLF) to all qualifying public service employees. Working with the DSS/HRA/DHS qualifies you as a public service employee and you may be able to take advantage of this program while working full-time and meeting the program?s other requirements. Please visit the Public Service Loan Forgiveness Program site to view the eligibility requirements: https://studentaid.ed.gov/sa/repay-loans/forgiveness-cancellation/public-service


Grievance & Appeals Quality Reviewer

VISITING NURSE SERVICE OF NEW YORK. Manhattan, NY

Overview

The Visiting Nurse Service of New York (VNSNY) is the nation’s largest not-for-profit home- and community-based health care organization, serving the five boroughs of New York City, and Nassau, Suffolk, and Westchester Counties. For 125 years, VNSNY has been committed to meeting the health care needs of New Yorkers with compassionate, high-quality home health care. We offer a wide range of services, programs, and health plans to meet the diverse needs of our patients, members, and clients from before birth to the end of life.
Each day, more than 13,000 VNSNY employees- including nurses, rehabilitation therapists, social workers, other allied professionals, and paraprofessionals- deliver compassionate care, unparalleled medical expertise, and 24/7 solutions and resources to more than 48,000 patients and members, helping them to live the best lives possible in their homes and communities.

Responsibilities

Identifies and resolves operational quality problems and inefficiencies within the Grievance & Appeals (G&A) department. Conducts daily reviews of G&A case files, letters, and database records against required criteria. Ensures compliance with CHOICE policies and procedures, regulatory requirements and business practices. Prepares summary reports and provides recommendations to reduce errors and improve process performance. Works under general supervision.Education: Bachelor’s degree in health care administration, human services or business administration or related discipline or the equivalent work experience in a related professional field required.Experience: Minimum four years professional experience in health care, including a minimum of two years in grievance and appeals in a Managed Care setting, required. Excellent verbal/written communication skills required. Proficient computer and typing skills, and knowledge of Microsoft Office (Word and Excel) and database software required. Demonstrated ability to work in a fast paced environment and effectively manage multiple grievances and appeals simultaneously required. Experience in one or more of the following areas: Audits, Compliance, and Medicare/Medicaid reporting required. Excellent verbal and written, presentation, communication, and writing skills required. Demonstrated ability to work effectively with employees at all levels of the organization required.


Hearing Officer

New York City ADMIN TRIALS AND HEARINGS
–
New York, NY
$49.94 – $53.85 an hour

A Hearing Officer (per session), under the direction of a Managing Attorney, conducts hearings and writes decisions in cases involving alleged violations of local laws and the rules of the City of New York or other laws or rules within OATH?s Hearings Division Tribunal jurisdiction. These areas of jurisdiction include, but are not limited to, violations involving cleanliness of the streets; disposal of waste; street vendors; restaurant, public health and environmental sanitation cases brought under the New York City Health Code; use of parks property; air, noise and water pollution cases; the Building and Fire Code violations; violations of consumer protection laws; violations of the laws and rules governing taxi, limousine, para-transit and commuter van services; and violations of the Criminal Justice Reform Act (CJRA).

Minimum Qual Requirements

1. A license to practice law in the State of New York, which must be maintained; and 2. Three years of recent satisfactory relevant legal experience subsequent to admission to the bar.

Preferred Skills

History of volunteerism, such as service in the AmeriCorps or Peace Corps, is viewed favorably.

Additional Information

NOTE: No incumbent shall work more than 17 hours per week in any two consecutive weeks, or more than 1,000 hours per year.

To Apply

Applicant must be a New York City resident within 90 days of appointment. Interested candidates should apply online via NYC Careers on the NYC.gov website (http://www.nyc.gov/html/careers/html/home/home.shtml). In addition, a writing sample should be submitted to HROATH@oath.nyc.gov with the candidate?s name and JVN number noted in the subject line. No telephone calls, faxes or personal inquiries please. Only those candidates under consideration will be contacted. For more information about OATH, visit us at: www.nyc.gov/oath


Appeals Hearing Manager

New York City HOUSING PRESERVATION & DVLPMNT
–
New York, NY
$65,000 – $70,000 a year

The Department of Housing Preservation and Development (HPD) administers the fifth largest Section 8 Program in the nation. Section 8, also known as the Housing Choice Voucher Program, provides Federal rent subsidies to eligible families for decent, safe, and affordable housing. HPD?s Section 8 Appeals Unit (Unit) manages and conducts federally mandated informal hearings and reviews, which are the mechanisms through which Section 8 Program participants/applicants appeal Program decisions concerning their eligibility for rent subsidies. The ideal candidate has experience with preparing cases for Section 8 informal hearings and reviews. The Appeals Hearing Manager will report directly to the Director and will assist with the day-to-day management of the Appeals Unit, specifically management/training of current and incoming hearing representatives, administrative staff and scheduling all aspects of the Appeals calendar. Specific duties will include but are not limited to: reviewing incoming appeals for pre-hearing disposition or assigning to a hearing representative; handling appeals correspondence and inquiries from the agency or the public; maintaining independent caseload and preparing cases for informal reviews and hearings as needed to ensure timely and efficient adjudication and scheduling of appeals; assigning cases and working with hearing representatives; developing, implementing and managing an on-going training program for current and new hearing representatives and administrative staff; maintaining internal appeals tracking database and preparing monthly and annual reports; serving as a liaison between the Appeals Unit and the DTR Subpoenas Unit and the NYC Law Department regarding Article 78 proceedings; representing the Unit and presenting cases of interest and appeals unit trends at internal meetings and assignment of special projects as needed

Minimum Qual Requirements

1. A baccalaureate degree from an accredited college and two years of experience in community work or community centered activities in an area related to the duties described above; or 2. High school graduation or equivalent and six years of experience in community work or community centered activities in an area related to the duties as described above; or 3. Education and/or experience which is equivalent to “1” or “2” above. However, all candidates must have at least one year of experience as described in “1” above.

Preferred Skills

1. Demonstrated ability to meet deadlines and manage multiple projects.2. Excellent research, analytical, and writing skills.3. Advanced knowledge of Microsoft Office.Candidates should have a proven track record of working in a high detail oriented, fast paced environment and handling cases specific to Section 8 Housing of varying complexity to obtain results promptly and meet deadlines. The selected candidates will be required to have an in-depth and comprehensive knowledge of the rules and policies governing the Section 8 program, including the Administrative Plan. Candidates must demonstrate strong organization, research, verbal and written communication skills, and be able to work independently and with other


No Fault Hearing Liaison, NYSI

American Arbitration Association
67 reviews
–
New York, NY

Overview

For over 40 years, the New York State Department of Financial Services (NYS DFS) has provided consumers and insurance carriers with the opportunity for the conciliation or arbitration of disputed claims in certain automobile insurance programs, and the American Arbitration Association (AAA) has administered the arbitration of such disputed claims in partnership with the NYS DFS.

As a No Fault Hearing Liaison, the successful candidate will be a contributing member of a highly collaborative team in our New York State Insurance Case Management Center. Reporting to the Supervisor, NYSI, the No Fault Hearing Liaison will primarily serve as a neutral liaison between parties, their representatives, and arbitrators on assigned No Fault arbitration cases. The Liaison will schedule arbitration hearings in a timely and efficient manner; monitor and update the hearing calendars to accommodate parties’ requests; and understands and complies with the rules and procedures of the American Arbitration Association, and the NYS DFS.

We offer a competitive salary and the opportunity to have a rewarding career in a fast-paced, results-driven environment. Our comprehensive benefits program includes the following: health and Rx, dental and orthodontia, vision, discounted pet insurance, disability insurance, basic and supplemental life insurance, 403(b) and Roth 403(b) retirement plans w/company match, a discounted corporate FitBit program, and generous paid time-off benefits.

Responsibilities

  • Maintains assigned aspects of case hearing administration (i.e. entry, maintenance, and report generation of scheduling information); explains and provides clear and accurate information to parties concerning procedures required by No Fault law and AAA.
  • Initiates and sustains accurate and efficient flow of information; processes requests from parties and arbitrators; schedules and batches hearings; responds immediately to inquiries related to NF Arbitration cases, monitors and follows-up to ensure cases are appropriately scheduled; provides arbitrator support on the hearing day (s) including last minute calendar adjustments such as adjournments and telephonic hearing requests.
  • Maintains records of party and arbitrator schedules, time off, and specific accommodations; prepares regular and ad hoc reports such as case searches, case aging, party availability, and arbitrator availability; ensures creation of related hearing and scheduling documentation and correspondence; performs related computer data entry.
  • Develops and sustains client relationships to ensure trust and respect for AAA and its services; communicates customer feedback and critique to immediate supervisor and makes suggestions for improvement.
  • Anticipates, troubleshoots and resolves problems efficiently, utilizing all available information and system data; weighs the importance of issues and escalates unresolved/complex ones appropriately.
  • Complies with established operating procedures and NYSDFS regulations; applies knowledge and understanding of applicable rules, regulations, and protocols; maintains confidentiality of client and case information; consults with supervisor for guidance to ensure quality and consistency standards.
  • Works in conjunction with the Divisional Vice President and the NYS Liaison to ensure that all matters are addressed.

Qualifications

Education & Experience: Bachelor’s degree; 3 years of experience with extensive customer contact in a client-centered work environment; or an equivalent mix of education and experience.

Reasoning Ability: Possesses ability to solve practical problems with a variety of variables; exercises sound judgment to make decisions in a manner consistent with the essential job functions, including the ability to determine importance and when to escalate issues to a supervisor.

Language Skills: Ability to read and interpret documents such as legal files, business correspondence and procedure manuals; ability to write routine reports and business correspondence; ability to speak effectively, both in person and by telephone, to customers, arbitrators, mediators or employees of the organization.

Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions and decimals; ability to compute rate, ratio, and percent and to draw and interpret bar graphs; ability to understand and interpret statistical reports, data charts and graphs.


ATTORNEY – NO FAULT ARBITRATION

No Fault Litigation/Arbitration Firm
–
Brooklyn, NY

Busy Brooklyn law firm specializing in No Fault Litigation and Arbitration seeks an associate to handle its arbitration calendar and hearings. Candidate will be expected to review and prepare the arbitration matters filed with the AAA, appear at hearings, and handle any appeals, if necessary. The position requires travel to Suffolk and Nassau Counties. Candidate must have strong work ethic, writing skills, and the ability to multitask and meet multiple deadlines.

Salary commensurate with experience.


Grievance & Appeals Specialist

EmblemHealth
–
New York, NY
The Grievance & Appeals specialist will respond to written/verbal grievances, complaints, appeals and disputes submitted by members and providers in accordance with NCQA, CMS, NY State and other regulations. Types of correspondence handled by the individual will include, but is not limited to, correspondence, payment disputes, complaints/grievances, and appeals.Work requires exercising considerable independent judgment and initiative in performing case file investigation. The financial consequences of an error could be significant. Reviews complex cases. Has extensive knowledge and experience in claims, benefits and member contracts.Accountabilities:

  • Provide written acknowledgment of all member and provider correspondence.
  • Independently review all receipts; interpret regulations and appropriately classify the inquiry.
  • Make critical decisions regarding research and investigation to appropriately categorize and resolve all inquiries.
  • Independently conduct thorough investigations of all member and provider correspondence by analyzing all the issues involved and obtaining responses and information from internal and external entities.
  • Facilitate the investigation of complex cases presented by members and providers.
  • Provide recommendations to management on cost saving opportunities, best practices and performance issues.
  • Assist the Manager/Supervisor in developing workflows and process efficiencies.
  • Prepare written responses to all member and provider correspondence that appropriately addresses each complainant’s issues and are structurally accurate.
  • Serve as liaison with EmblemHealth departments, delegated entities, medical groups and network physicians to ensure timely resolution of cases.
  • Monitor daily and weekly pending reports and personal SAWS worklists; make necessary follow-up calls to internal and external entities to ensure that cases are completed within the applicable timeframe.
  • Liaise with Claims to ensure determinations are effectuated within stringent timeframes.
  • Classify and code ESaws inquiries appropriately; document actions taken in investigation for auditing and reporting.
  • Prepare cases for medical and administrative review detailing the findings of their investigation for consideration in the plan’s determination.
  • Regular attendance is an essential function of the job. Performs other duties as assigned or required.

Knowledge,Skills & Abilities:

  • Excellent product knowledge
  • Excellent problem solving and analytical skills
  • Ability to work under pressure and deliver accurate and timely results
  • Excellent verbal and written communication skills
  • Excellent organization skills
Education & Experience:

  • Bachelor’s Degree.
  • 2 – 3 years of work experience in a related field; experience in a managed care/compliance environment preferred.
  • Additional years of related experience may be used in place of educational requirements.
  • Experience in comprehending and producing business correspondence.
  • Working knowledge of workflow processes.
  • Customer service experience desirable.
  • Proficiency in MS Office applications (especially word processing, and database/spreadsheet).

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