MAS - CGS Administrators, LLC - GS00F246DA

GENERAL SERVICES ADMINISTRATION

Federal Acquisition Service Authorized Federal Supply Schedule FSS Price List

Online access to contract ordering information, terms and conditions, pricing, and the option to create an electronic delivery order are available through GSA Advantage!®. The website for GSA Advantage!® is:

https://www.GSAAdvantage.gov.

MULTIPLE AWARD SCHEDULE (MAS)

Contract Number: GS-00F-246DA For more information on ordering go to the following website: https://www.gsa.gov/schedules.

Contract Period: August 3, 2016 through August 2, 2026

Contractor: CGS ADMINISTRATORS, LLC 26 Century Boulevard, Suite 610

Nashville, TN 37214-3683

Business Size: Large Business

In accordance with 13 C.F.R. 121.404, the Contractor is ineligible to participate in any RFQ that is set aside for small business where the subject contract’s awarded size status for the preponderance NAICS designated in the RFQ is “other than small”.

Telephone: (615) 782/4532 FAX Number: (615) 782/4420 Web Site: www.cgsadmin.com E-mail: shannon.happel@cgsadmin.com Contract Administration: Shannon Happel

Price list current as of Modification PS-0020 effective August 1, 2023

CUSTOMER INFORMATION:

1a. Table of Awarded Special Item Number(s) with appropriate cross-reference to page numbers:

SIN SIN Description 541214 Payroll Services

541611 Management and Financial Consulting, Acquisition and Grants

Management Support, and Business Program and Project Management Services

54151S Information Technology Professional Services

54151SSTLOC

54151HEAL

Health Information Technology Services

54151HEALSTLOC

561422 Automated Contact Center Solutions (ACCS) OLM Order-Level Materials (OLM)

1b. Identification of the lowest priced model number and lowest unit price for that model for each special item number awarded in the contract. This price is the Government price based on a unit of one, exclusive of any quantity/dollar volume, prompt payment, or any other concession affecting price.

Those contracts that have unit prices based on the geographic location of the customer, should show the range of the lowest price, and cite the areas to which the prices apply. Not Applicable

1c. If the Contractor is proposing hourly rates a description of all corresponding commercial job titles, experience, functional responsibility and education for those types of employees or subcontractors who will perform services shall be provided. If hourly rates are not applicable, indicate “Not applicable” for this item. See Price List

2. Maximum Order: $250,000.00 (SIN OLM); $500,000.00 (SINs 54151S, 54151HEAL, 561422);

$1,000,000.00 (SINs 541214, 541611)

3. Minimum Order: $100.00

4. Geographic Coverage (delivery Area): Domestic only

5. Point(s) of production (city, county, and state or foreign country): Same as company address

6. Discount from list prices or statement of net price: Government net prices (discounts already deducted).

See Attachment.

7. Quantity discounts: None Offered

8. Prompt payment terms: Net 30 days. Information for Ordering Offices: Prompt payment terms cannot be negotiated out of the contractual agreement in exchange for other concessions.

9. Foreign items (list items by country of origin): None

10a. Time of Delivery (Contractor insert number of days): Specified on the Task Order

10b. Expedited Delivery. The Contractor will insert the sentence “Items available for expedited delivery are noted in this price list.” under this heading. The Contractor may use a symbol of its choosing to highlight items in its price list that have expedited delivery: Contact Contractor

10c. Overnight and 2-day delivery. The Contractor will indicate whether overnight and 2-day delivery are available. Also, the Contractor will indicate that the schedule customer may contact the Contractor for rates for overnight and 2-day delivery: Contact Contractor

10d. Urgent Requirements. The Contractor will note in its price list the “Urgent Requirements” clause of its contract and advise agencies that they can also contact the Contractor’s representative to effect a faster delivery: Contact Contractor

11. F.O.B Points(s): Destination

12a. Ordering Address(es): Same as company address

12b. Ordering procedures: See Federal Acquisition Regulation (FAR) 8.405-3.

13. Payment address(es): Same as company address

14. Warranty provision.: Contractor’s standard commercial warranty.

15. Export Packing Charges (if applicable): N/A

16. Terms and conditions of rental, maintenance, and repair (if applicable): N/A

17. Terms and conditions of installation (if applicable): N/A

18a. Terms and conditions of repair parts indicating date of parts price lists and any discounts from list prices (if applicable): N/A

18b. Terms and conditions for any other services (if applicable): N/A

19. List of service and distribution points (if applicable): N/A

20. List of participating dealers (if applicable): N/A

21. Preventive maintenance (if applicable): N/A

22a. Environmental attributes, e.g., recycled content, energy efficiency, and/or reduced pollutants: N/A

22b. If applicable, indicate that Section 508 compliance information is available for the information and communications technology (ICT) products and services offered and show where full details can be found (e.g., Contractor’s website or other location). ICT accessibility standards can be found at https://www.section508.gov/. N/A

23. Unique Entity Identifier (UEI) number: LLNXG14PXPB3

24. Notification regarding registration in System for Award Management (SAM) database: Registered

Final Pricing:

The rates shown below include the Industrial Funding Fee (IFF) of 0.75%.

SIN(s) Labor Category Site 3/23/23 –

8/2/24 8/3/24 – 8/2/25

8/3/25 – 8/2/26

541611, 541214 ADVOCATE, CUST SVC I Contractor Facility $50.58 $52.10 $53.66

541611, 541214 ADVOCATE, CUST SVCII Contractor Facility $66.98 $68.98 $71.05

541611, 541214 ANL, OPERATIONS Contractor Facility $92.53 $95.31 $98.17

541611, 541214 TECH, COST REPT SR Contractor Facility $73.73 $75.94 $78.22

541611, 541214 ADMIN ASSOC I Contractor Facility $55.82 $57.50 $59.22

541611, 541214 AUDITOR I Contractor Facility $70.89 $73.01 $75.21

541611, 541214 AUDITOR III Contractor Facility $112.99 $116.38 $119.87

541611, 541214 ACCOUNTANT I Contractor Facility $71.55 $73.69 $75.90

541611, 541214 Processor, Lead Claims Contractor Facility $88.70 $91.36 $94.10

541611, 541214 Processor, Claims II Contractor Facility $61.10 $62.93 $64.82

541611, 541214 Processor, Claims I Contractor Facility $55.42 $57.09 $58.80

541611, 541214 ADVOCATE, CUST SVC I Customer Facility $49.83 $51.32 $52.86

541611, 541214 ADVOCATE, CUST SVCII Customer Facility $65.97 $67.95 $69.99

541611, 541214 ANL, OPERATIONS Customer Facility $91.14 $93.88 $96.69

541611, 541214 TECH, COST REPT SR Customer Facility $72.63 $74.80 $77.05

541611, 541214 ADMIN ASSOC I Customer Facility $54.99 $56.64 $58.34

541611, 541214 AUDITOR I Customer Facility $69.82 $71.92 $74.08

541611, 541214 AUDITOR III Customer Facility $111.29 $114.63 $118.07

541611, 541214 ACCOUNTANT I Customer Facility $70.47 $72.59 $74.76

541611, 541214 Processor, Lead Claims Customer Facility $87.37 $89.99 $92.69

541611, 541214 Processor, Claims II Customer Facility $60.18 $61.99 $63.85

541611, 541214 Processor, Claims I Customer Facility $54.59 $56.23 $57.92

54151S, 561422 Associate, EDI Operations I Both $53.87 $55.48 $57.15

54151S, 561422 Associate, EDI Operations II Both $81.62 $84.07 $86.60

54151S, 561422 Associate, EDI Operations III Both $86.53 $89.13 $91.80

54151S, 561422 Associate, EDI Operations Lead Both $134.99 $139.04 $143.21

54151S, 561422 Administrator, Identity and Access Management

Both $81.88 $84.33 $86.86

54151S, 561422 Analyst, Senior Identity and Access Management

Both $143.92 $148.24 $152.69

54151S, 561422 Identity and Access Management Technician

Both $66.97 $68.98 $71.04

54151S, 561422 Analyst, System Testing I Both $93.40 $96.20 $99.09

54151S, 561422 Analyst, IS Security Both $163.16 $168.06 $173.10

54151S, 561422 Analyst, Business Systems I Both $114.28 $117.71 $121.24

3/23/23 –

8/2/24 8/3/24 – 8/2/25

8/3/25 – 8/2/26

54151S, 561422 Analyst, Business Systems II Both $125.70 $129.47 $133.36

54151S, 561422 Analyst, Business Test I Both $86.53 $89.13 $91.80

54151S, 561422 Analyst, Business Test II Both $88.25 $90.90 $93.63

54151S, 561422 Analyst, Business I Both $76.72 $79.03 $81.40

54151S, 561422 Analyst, Business III Both $114.28 $117.71 $121.24

54151S, 561422 Analyst, Lead Business Both $150.55 $155.06 $159.72

54151S, 561422 Analyst, Business Operation Systems Both $115.91 $119.39 $122.97

54151S, 561422 Analyst, Statistical Programming II Both $103.18 $106.28 $109.47

54151S, 561422 Analyst, Statistical Programming III Both $136.16 $140.25 $144.45

54151S, 561422 Analyst, Statistical Programming IV Both $164.53 $169.46 $174.55

54151S, 561422 Tactical Coordinator Both $107.75 $110.98 $114.31

54151S, 561422 Senior Technology Support Specialist Both $90.36 $93.07 $95.86

54151S, 561422 Administrator, System Support Both $115.91 $119.39 $122.97

54151S, 561422 Administrator, Senior System Support Both $121.13 $124.76 $128.50

54151S, 561422 Analyst, Senior System Support Both $193.24 $199.04 $205.01

54151S, 561422 Analyst, Database II Both $173.59 $178.80 $184.16

54151S, 561422 Data Analyst III Both $130.60 $134.52 $138.56

54151S, 561422 Senior IS Security Risk Analyst Both $180.72 $186.14 $191.73

54151S, 561422 Junior Developer Both $78.36 $80.71 $83.13

54151S, 561422 Lead, Project I Both $130.60 $134.52 $138.56

54151S, 561422 Lead, Project II Both $189.37 $195.05 $200.90

54151S, 561422 Systems Programmer/Analyst Both $230.80 $237.72 $244.86

54151S, 561422 JAVA Developer/Designer II Both $132.72 $136.70 $140.80

54151S, 561422 Programmer/Analyst, Applications Development

Both $126.84 $130.65 $134.57

54151S, 561422 Programmer/Analyst, Senior Applications Development

Both $141.61 $145.85 $150.23

54151S, 561422 Analyst, Applications Development Systems

Both $141.28 $145.52 $149.89

54151S, 561422 Analyst, Senior Applications Development Systems

Both $193.06 $198.85 $204.81

54151S, 561422 Senior Statistician Both $126.16 $129.95 $133.85

54151S, 561422 Chief Statistician Both $192.26 $198.03 $203.97

54151S, 561422 Manager, IS System Support Both $208.53 $214.79 $221.23

54151S, 561422 Manager, Identity/Access Management Both $203.77 $209.88 $216.18

54151S, 561422 Manager, Statistics and Research Both $191.79 $197.54 $203.47

54151S, 561422 Director, Claims Customer Service Both $184.47 $190.01 $195.71

3/23/23 –

8/2/24 8/3/24 – 8/2/25

8/3/25 – 8/2/26

54151S, 561422 Director, Program Both $262.70 $270.58 $278.70

54151S, 561422 Director, IS System Support Both $262.70 $270.58 $278.70

54151S, 561422 Director, System Support Both $204.49 $210.62 $216.94

54151S, 561422 Officer, System Security Both $221.95 $228.61 $235.47

54151S, 561422 Vice President Both $310.16 $319.47 $329.05

54151HEAL Associate, EDI Operations I (HEALTH IT) Both $53.87 $55.48 $57.15

54151HEAL Associate, EDI Operations II (HEALTH IT) Both $81.62 $84.07 $86.60

54151HEAL Associate, EDI Operations III (HEALTH IT) Both $86.53 $89.13 $91.80

54151HEAL Associate, EDI Operations Lead (HEALTH

IT)

Both $134.99 $139.04 $143.21

54151HEAL Administrator, Identity and Access Management (HEALTH IT)

Both $81.88 $84.33 $86.86

54151HEAL Analyst, Senior Identity and Access Management (HEALTH IT)

Both $143.92 $148.24 $152.69

54151HEAL Identity and Access Management Technician (HEALTH IT)

Both $66.97 $68.98 $71.04

54151HEAL Analyst, System Testing I (HEALTH IT) Both $93.40 $96.20 $99.09

54151HEAL Analyst, IS Security (HEALTH IT) Both $163.16 $168.06 $173.10

54151HEAL Analyst, Business Systems I (HEALTH IT) Both $114.28 $117.71 $121.24

54151HEAL Analyst, Business Systems II (HEALTH IT) Both $125.70 $129.47 $133.36

54151HEAL Analyst, Business Test I (HEALTH IT) Both $86.53 $89.13 $91.80

54151HEAL Analyst, Business Test II (HEALTH IT) Both $88.25 $90.90 $93.63

54151HEAL Analyst, Business I (HEALTH IT) Both $76.72 $79.03 $81.40

54151HEAL Analyst, Business III (HEALTH IT) Both $114.28 $117.71 $121.24

54151HEAL Analyst, Lead Business (HEALTH IT) Both $150.55 $155.06 $159.72

54151HEAL Analyst, Business Operation Systems

(HEALTH IT)

Both $115.91 $119.39 $122.97

54151HEAL Analyst, Statistical Programming II

(HEALTH IT)

Both $103.18 $106.28 $109.47

54151HEAL Analyst, Statistical Programming III

(HEALTH IT)

Both $136.16 $140.25 $144.45

54151HEAL Analyst, Statistical Programming IV

(HEALTH IT)

Both $164.53 $169.46 $174.55

54151HEAL Tactical Coordinator (HEALTH IT) Both $107.75 $110.98 $114.31

54151HEAL Senior Technology Support Specialist

(HEALTH IT)

Both $90.36 $93.07 $95.86

54151HEAL Administrator, System Support (HEALTH

IT)

Both $115.91 $119.39 $122.97

54151HEAL Administrator, Senior System Support

(HEALTH IT)

Both $121.13 $124.76 $128.50

54151HEAL Analyst, Senior System Support (HEALTH Both $193.24 $199.04 $205.01

3/23/23 –

8/2/24 8/3/24 – 8/2/25

8/3/25 – 8/2/26

IT)

54151HEAL Analyst, Database II (HEALTH IT) Both $173.59 $178.80 $184.16

54151HEAL Data Analyst III (HEALTH IT) Both $130.60 $134.52 $138.56

54151HEAL Senior IS Security Risk Analyst (HEALTH

IT)

Both $180.72 $186.14 $191.73

54151HEAL Junior Developer (HEALTH IT) Both $78.36 $80.71 $83.13

54151HEAL Lead, Project I (HEALTH IT) Both $130.60 $134.52 $138.56

54151HEAL Lead, Project II (HEALTH IT) Both $189.37 $195.05 $200.90

54151HEAL Systems Programmer/Analyst (HEALTH

IT)

Both $230.80 $237.72 $244.86

54151HEAL JAVA Developer/Designer II (HEALTH IT) Both $132.72 $136.70 $140.80

54151HEAL Programmer/Analyst, Applications Development (HEALTH IT)

Both $126.84 $130.65 $134.57

54151HEAL Programmer/Analyst, Senior Applications Development (HEALTH IT)

Both $141.61 $145.85 $150.23

54151HEAL Analyst, Applications Development Systems (HEALTH IT)

Both $141.28 $145.52 $149.89

54151HEAL Analyst, Senior Applications Development Systems (HEALTH IT)

Both $193.06 $198.85 $204.81

54151HEAL Senior Statistician (HEALTH IT) Both $126.16 $129.95 $133.85

54151HEAL Chief Statistician (HEALTH IT) Both $192.26 $198.03 $203.97

54151HEAL Manager, IS System Support (HEALTH IT) Both $208.53 $214.79 $221.23

54151HEAL Manager, Identity/Access Management

(HEALTH IT)

Both $203.77 $209.88 $216.18

54151HEAL Manager, Statistics and Research

(HEALTH IT)

Both $191.79 $197.54 $203.47

54151HEAL Director, Claims Customer Service

(HEALTH IT)

Both $184.47 $190.01 $195.71

54151HEAL Director, Program (HEALTH IT) Both $262.70 $270.58 $278.70

54151HEAL Director, IS System Support (HEALTH IT) Both $262.70 $270.58 $278.70

54151HEAL Director, System Support (HEALTH IT) Both $204.49 $210.62 $216.94

54151HEAL Officer, System Security (HEALTH IT) Both $221.95 $228.61 $235.47

54151HEAL Vice President (HEALTH IT) Both $310.16 $319.47 $329.05

541611, 541214 Administrator, Project Both $105.72 $108.89 $112.16

541611, 541214 Analyst, Appeals Both $134.96 $139.01 $143.18

541611, 541214 Analyst, Business II Both $105.72 $108.89 $112.16

541611, 541214 Analyst, Quality Assurance Both $69.88 $71.98 $74.14

541611, 541214 Analyst, Senior Quality Assurance Both $81.46 $83.90 $86.42

541611, 541214 Claims Customer Service Advocate II Both $69.88 $71.98 $74.14

541611, 541214 Claims Customer Service Advocate III Both $75.43 $77.69 $80.02

3/23/23 –

8/2/24 8/3/24 – 8/2/25

8/3/25 – 8/2/26

541611, 541214 Coordinator, Claims Customer Service Both $81.46 $83.90 $86.42

541611, 541214 Director, Claims Customer Service Both $216.55 $223.05 $229.74

541611, 541214 Director, Claims Operations Both $200.73 $206.75 $212.95

541611, 541214 Manager, Claims Customer Service Both $157.24 $161.96 $166.82

541611, 541214 Manager, Claims Operations Both $134.96 $139.01 $143.18

541611, 541214 Manager, Customer Service Both $145.68 $150.05 $154.55

541611, 541214 Manager, Operations Both $134.96 $139.01 $143.18

541611, 541214 Medical Reviewer I Both $97.86 $100.80 $103.82

541611, 541214 Medical Reviewer III Both $125.01 $128.76 $132.62

541611, 541214 Medical Reviewer Senior Both $134.96 $139.01 $143.18

541611, 541214 Processor, Claims I Both $55.52 $57.18 $58.90

541611, 541214 Specialist, Appeals Both $75.43 $77.69 $80.02

541611, 541214 Specialist, Lead Appeals Both $88.00 $90.64 $93.36

541611, 541214 Specialist, Training I Both $88.00 $90.64 $93.36

541611, 541214 Supervisor, Claims Customer Service Both $105.72 $108.89 $112.16

541611, 541214 Supervisor, Claims Operations Both $105.72 $108.89 $112.16

541611, 541214 Supervisor, Customer Service Both $105.72 $108.89 $112.16

541611, 541214 Technician, Accounting II Both $69.88 $71.98 $74.14

541611, 541214 Technician, Data Preparation Senior Both $59.92 $61.72 $63.57

LABOR CATEGORY DESCRIPTIONS

ADVOCATE, CUST SVC I

Functional Responsibilities: Ensures effective customer relations by responding accurately, timely and courteously to telephone, written, web, or walk-in inquiries. Accurately documents inquiries. Initiates or processes adjustments or performs other research as needed to resolve inquiries. Coordinates with other departments to resolve problems. Responds to, researches and/or assists with priority inquiries and special projects as required by management. Provides feedback to management regarding customer problems, questions and needs. Maintains accurate records on complaints and/or other customer comments, and makes recommendations for changes to management. Follows through on complaints until resolved or reports to management as needed. Maintains basic knowledge of quality work instructions and company policies. Assists with process improvements through the recommendation of changes in procedures and techniques discovered during daily operations. Maintains all departmental productivity, quality, and timeliness standards. Identifies and promptly reports and/or refers suspected fraudulent activities and system errors to the appropriate departments.

Minimum Experience: 0 years.

Minimum Education: High School Diploma, Associate Degree preferred.

ADVOCATE, CUST SVCII

Functional Responsibilities: Ensures effective customer relations by responding accurately, timely, and courteously to telephone, written, web, or walk-in inquiries. Handles situations which may require adaptation of response or extensive research. Accurately documents inquiries. Initiates or processes adjustments or performs other research as needed to resolve inquiries. Coordinates with other departments to resolve problems. Responds to, researches and/or assists with priority inquiries and special projects as required by management. Provides feedback to management regarding customer problems, questions and needs. Maintains accurate records on complaints and/or other customer comments, and makes recommendations for changes to management. Follows through on complaints until resolved or reports to management as needed. Maintains basic knowledge of quality work instructions and company policies. Assists with process improvements through the recommendation of changes in procedures and techniques discovered during daily operations. Maintains all departmental productivity, quality, and timeliness standards. Assist with the training of new employees and cross training of coworkers.

Minimum Experience: 1 year claims processing or customer service experience.

Minimum Education: High School Diploma, Associate Degree preferred.

ANL, OPERATIONS

Functional Responsibilities: Evaluates existing procedures and processes to make recommendations for improvement. Monitors reports to assess the impact of performance on key measures. Provides reports and/or analyses of internal performance metric for various projects as well as for individual performance against those metrics. Assists in the implementation and maintenance of systems or processes to include testing. May manage and relay the purpose, scope, and status of each implementation to management. Develops and maintains written procedures within departmental and organizational standards. May document and streamline automated procedures into end-user training material. Conducts workflow and process audits of staff and reference materials as needed. Works with staff and manager to research and document errors, progress, performance or other metrics to assess efficiency. Provides training for new employees and ongoing training as workflow efficiencies are revised.

Generates data to prepare reports and maintain databases and/or requests reports on specific statistics in order to analyze trends. Maintains area reports. Quality check records affecting accuracy of reports by researching and testing processes and methods. Maintains close contact with management to provide updates on any issue/projects. Completes special projects and informs management of any trends or changes in statistical reports. May serve as liaison between the department and other internal/external groups.

Minimum Experience: 2 years data analysis or related operations experience.

Minimum Education: Bachelor’s Degree.

TECH, COST REPT SR

Functional Responsibilities: Revises and reopens the cost report data files on the automated system incorporating the audit adjustments. Inputs or converts original data files received from providers.

Prepares the automated desk review. Completes limited desk reviews and settlements for certain cost reports. Analyzes and determines cost report acceptability to ensure data conforms to contractual guidelines. Prepares data files and submission of cost reporting information system in accordance with contractual requirements. Researches information requests on an ongoing basis. Upon completion submits data to responsible administrator. Completes revision of cost reports to include verification of audit adjustments and preparation of the package deliverables, while ensuring timeliness standards are met. Reconciles data reported in the area's system, which is subsequently reported to the contractor. In addition to the verification process, the reconciliation includes working with audit staff to ensure all performance objectives meet their CMS timeliness standards. Determines acceptability of various cost reports. This includes the acceptance process, rejecting cost reports, and answering provider questions when necessary. Works with vendor and vendor software to ensure that the departments automated software is properly updated. Assists supervisor in completion of other cost report activities such as weekly/monthly reconciliations, quality management system policies, freedom of information act requests, answering questions about area software, and helping auditors with their procedures.

Minimum Experience: 2 years of cost reporting activities to include in-depth experience with automated cost report software.

Minimum Education: Associate Degree.

ADMIN ASSOC I

Functional Responsibilities: Performs general clerical duties and administrative support including ordering supplies, arranging travel, maintaining calendars, and providing phone coverage for upper management. Maintains area specific reports or presentations. Updates or logs correspondence and/or documents.

Minimum Experience: 1 year office or administrative support experience.

Minimum Education: Associate Degree.

AUDITOR I

Functional Responsibilities: Conducts audits of the financial, management, and administrative procedures of assigned divisions, providers, departments, and various lines of businesses throughout the organization to ensure that procedures are in compliance. Audits include interviewing key personnel, conducting testing, analyzing existing financial and management practices to determine effectiveness, and reviewing relevant documentation to support findings. Develops detailed reports on each audit conducted. Reports include a review of findings and an identification of recommendation to correct any deficiencies and methods for improvement to processes. Conducts special audit studies from management, such as those required to discover mechanical controls for prevention of fraud. Prepares reports of finding and recommendations for management. Assists other auditors in completing their assignments as a means of maximizing audit efficiency and thus reducing lost time and involvement of corporate personnel.

Minimum Experience: 0 years.

Minimum Education: Bachelor’s Degree.

AUDITOR III

Functional Responsibilities: Conducts internal and/or external timely operational, financial, and/or compliance audits of divisions, departments, providers, and activities of the corporation. Identifies, documents, and evaluates business risks. Develops written audit programs. Conducts testing and analysis of existing controls to determine adequacy and effectiveness. Prepares written work papers to document testing results and conclusions reached. Documents issues, the causes of those issues, and their effects on the process/function and the corporation. Serves as Lead Auditor on more complex audit assignments. Drafts recommendations to limit risks and improve processes, functions and activities.

Writes audit reports for corporate executive management that clearly and effectively convey engagement evaluations, conclusions and recommendations. Collects and analyzes data to detect deficient controls, duplicated effort, fraud, or non-compliance with laws, regulations, and management policies. Develops detailed reports on each audit conducted. Reports include a review of findings and an identification of recommendation to correct any deficiencies and methods for improvement to processes. Examine and evaluate financial and information systems, recommending controls to ensure system reliability and data integrity. Conducts special audit studies from management, such as those required to discover mechanical controls for prevention of fraud. Prepares reports of findings and recommendations for management. Provides training to and assists or leads other auditors in completing their assignments as a means of maximizing audit efficiency and thus reducing lost time and involvement of corporate personnel. Strives to expand knowledge of applicable laws, regulations, program instructions, and technology through self-study, corporate offerings, and formal training programs.

Minimum Experience: 5 years auditing experience.

Minimum Education: Bachelor’s Degree, Master’s Degree preferred.

ACCOUNTANT I

Functional Responsibilities: Reconciles assigned accounts. Initiates and/or processes general ledger, commissions, and/or journal entries into various accounts. Prepares spreadsheets and/or ensures that entries are entered into the accounting system. Assists coworkers in preparation and/or review of daily activity, monthly, quarterly, and/or annual filings as required by regulatory agencies and/or internal requirements, as well as entries made to various systems. Prepares reports for financial analysis, forecasting, budgeting, trending, and/or results analysis to ensure transactions in the ledger tie to statistical files and/or various financial reports. Performs analysis of financial data to identify problem areas and/or report to management. Maintains accurate general ledger (G/L) accounts. This includes performing monthly, weekly, and/or daily reconciliations. May assist with special projects as assigned by the manager to include coordination between areas, allocation of resources, formulating solutions to problems, providing timely feedback to the manager and/or developing and/or implementing job procedures/controls in accordance with policies.

Minimum Experience: 0 years.

Minimum Education: Bachelor’s Degree.

PROCESSOR, CLAIMS I

Functional Responsibilities: Responsible for the accurate and timely processing of claims. Researches and processes claims according to business regulation, internal standards and processing guidelines.

Verifies the coding of procedure and diagnosis codes. Resolves system edits, audits and claims errors through research and use of approved references and investigative sources. Coordinates with internal departments to work edits and deferrals, updating the patient identification, other health insurance, provider identification and other files as necessary.

Minimum Experience: 1 year experience in a healthcare or insurance environment.

Minimum Education: High School Diploma or equivalent.

PROCESSOR, CLAIMS II

Functional Responsibilities: Reviews and adjudicates complex or specialty claims. Determines whether to return, deny or pay claims following organizational policies and procedures. Assists in training or mentoring new staff members. Examines and processes complex or specialty claims according to business/contract regulations, internal standards and examining guidelines. Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes. Verifies that claims have been keyed correctly. Ensures that claims are processing according to established quality and production standards. Corrects processing errors by reprocessing, adjusting, and/or recouping claims. Researches and resolves claims edits and deferrals. Performs research on claim problems by utilizing policies, procedures, reference materials, forms and coordinates with various internal support areas. Responds to routine correspondence and completes spreadsheet if applicable.

Minimum Experience: 2 years of processing, researching and adjudicating claims experience.

Minimum Education: High School Diploma or equivalent.

PROCESSOR, CLAIMS LEAD

Functional Responsibilities: Functions as the team lead and subject-matter expert for a claims area.

Responsible for creating reports, distributing workload and training new employees. Responds accurately and timely to inquiries from team members, including management, concerning claims processing and other technical issues. Investigates and initiates resolutions to complex claims problems. Trains and assists new employees and unit personnel to unsure consistent application of established guidelines.

Identifies issues with procedures and processes and provides feedback to management on changes and development. Serves as liaison with other departments to address claim, system and quality issues. May perform some testing functions and attend/participate in meetings as needed.

Minimum Experience: 4 years of processing, researching and adjudicating claims experience.

Minimum Education: High School Diploma or equivalent.

ASSOCIATE, EDI OPERATIONS I

Functional Responsibilities: Provides telephone support and information via the info call tracking system, managing one or more customer service logs. Ensures timely and accurate completion of requests about electronic data interchange (EDI) products and services, utilizing a relational database for tracking purposes. Maintains expedient and accurate service levels in filling requests for EDI products and services. Supports in set-up of electronic transactions, software, electronic remittances, and support of submitter testing certification. Oversees written and electronic requests relating to EDI. Prepares material for monthly audits and provides support in the audit process. Processes requests/responses received from other areas.

Minimum Experience: 0 years Minimum Education: Associate Degree in Computer Science, Information Technology, or other job related field

ASSOCIATE, EDI OPERATIONS II

Functional Responsibilities: Provides quality/timely internal/external customer technical support/service for variety of insurance contracts as assigned. This encompasses, but is not limited to, support of communication interfaces/transactions/functions as required by insurance laws (such as support of claims, remit advices, inquiry/response for claims status/eligibility, enrollment, premium payment etc.), support of all current formats/transactions required by law/BCBSSC lines of business.

Responsible for the setup of all electronic transactions submission by processing enrollment applications, updating associated system files, and managing customer notification.

Minimum Experience: 2 years of applicable EDI experience Minimum Education: Associate Degree in Information Systems/Technology, Computer Science, or other job related field. or 2 years of technical operations support experience or other applicable experience.

ASSOCIATE, EDI OPERATIONS III

Functional Responsibilities: Provides technical support to both external/internal customers for all electronic transactions, connectivity and communications interfaces, software support, testing, implementation and product development. facilitates communications between programming staff and contracting organizations to resolve system problems. Manages projects including research and analysis involving various business mandates, system transitions, internal operational procedures improvements and standard system and release testing as needed for new technology. Provides input and assistance and has an integral role in the design and development of new EDI products and services as required by supported contracts. Serves as departmental representative on technical advisory groups and conference workgroups in review/identification/resolution of EDI processing issues for supported contracts. Mentors new/fellow staff members in EDI process/set-up/testing, using all research tools and meeting departmental processing goals. May operate as liaison to assigned contract, any future business partners with regard to all network support activities.

Minimum Experience: 4 years of applicable EDI experience.

Minimum Education: Associate Degree in Information Systems/Technology, Computer Science, or other job related field. or 2 years of technical operations support experience or other applicable experience.

ASSOCIATE, EDI OPERATIONS LEAD

Functional Responsibilities: Handles escalated and complex EDI issues from customers to include researching, analyzing, and resolving problems. Communicates findings to customers. Responsible for project leadership that may involve business mandates relating to EDI issues, training and work instructions for new and existing staff, system and new business transitions, departmental process improvements, standard system testing and support, etc. Develops and presents a variety of routine and AD HOC reports on departmental statistics as requested by management and as needed for customers.

Minimum Experience: 6 years of applicable EDI experience.

Minimum Education: Associate Degree in Information Systems/Technology, Computer Science, or other job related field. or 2 years of technical operations support experience or other applicable experience.

ADMINISTRATOR, IDENTITY and ACCESS MANAGEMENT Functional Responsibilities: Create, modify, delete, maintain, and monitor system access identification for corporate email system, LAN, enterprise server (RACF) applications and subsystems, remote access, web browsing, and/or application level security databases. Review, verify, and implement security requests. Work with other areas of Information Systems to provide solutions for customers. Dispatch work to security points of contact for completion and/or process break/fix and service severity level requests to meet customer needs. Provide instruction, problem resolution, and follow-up to external customers and internal employees. May train new team members on procedures and problem resolution. Perform system access reviews to ensure compliance with corporate security policies and standards. Participate in related project work as needed such as documentation of work, process implementations and procedure updating. Create and/or review data access reports to research service requests or issues. May also be asked to review reports to ensure compliance with corporate information security policies, standards, guidelines and procedures.

Minimum Experience: 2 years IT technical experience in infrastructure and/or applications.

Minimum Education: Bachelor's degree in Computer Science, Information Technology or other job related degree. or 4 years of job related work experience or 2 years of job related experience plus an associate’s degree in Computer Science, Information Technology or other job related degree

ANALYST, SENIOR IDENTITY and ACCESS MANAGEMENT Functional Responsibilities: Design and configure system access rules and permissions to protect information resources within the enterprise. Provide subject matter expert level assistance for security measures, safeguards, and requirements. Work with System Security Officers and I/S area support groups to address system security issues, audits, reviews, evaluations, standards, and best practices.

Ensure compliance within the company, state and federal regulations and ascertain and correct security risks/violations where applicable. Evaluate new information security technology, considering business needs against security concerns. Develop and maintain computer programs used for security monitoring, resolution of any audit findings, daily batch cycle processing, etc. Review, recommend, and implement security system configuration, access rules, and procedures in accordance with company policies, standards, and external customer requirements. Ensure service levels are met and projects are completed within specified time frames. Execute and manage all directives from management in regard to urgent data security issues to include highly visible issues that will be reported to senior management.

Mentor, train, and/or assist less experienced staff on system access issues, procedures, and related questions.

Minimum Experience: 6 years IT technical experience in infrastructure and/or applications including 4 years identity/access management experience creating, modifying and deleting user access accounts and permissions.

Minimum Education: Bachelor's degree in Computer Science, Information Technology or other job related degree. or 4 years of job related work experience or 2 years of job related experience plus an associate’s degree in Computer Science, Information Technology or other job related degree

IDENTITY and ACCESS MANAGEMENT TECHNICIAN Functional Responsibilities: Learn to create, modify, delete, maintain, and monitor system access identification for corporate email system, LAN, enterprise server (RACF) applications and subsystems, remote access, web browsing, and/or application level security databases. Assist in the review, verification, and implementation of security requests. Perform system access reviews to ensure compliance with corporate security policies and standards. Participate in related project work as needed such as documentation of work, process implementations and procedure updating. Create and/or review data access reports to research service requests or issues. May also be asked to review reports to ensure compliance with corporate information security policies, standards, guidelines and procedures.

Minimum Experience: 0 years

Minimum Education: Bachelor's degree Computer Science, Information Technology or other job related degree or 4 years of job related work experience or 2 years of job related experience plus an associate’s degree in Computer Science, Information Technology or other job related degree

ANALYST, SYSTEM TESTING I

Functional Responsibilities: Create and execute test cases. During the testing process monitor the system for exceptions and other items requiring post-test attention. Attend project meetings to provide feedback and input for design documents. Serve as liaison between customers and I/S development.

Assist customers with questions regarding the testing process, defects, etc. Prepare written reports and analyses, including recommendations. Mentor and provide guidance to testing staff.

Minimum Experience: 3 years of IT experience to include experience developing test plans and/or matrices Minimum Education: Bachelor's degree in Computer Science, Information Technology or other job related degree. or 4 years of job related work experience or 2 years of job related experience plus an associate’s degree in Computer Science, Information Technology or other job related degree

ANALYST, IS SECURITY

Functional Responsibilities: Responsible for analyzing compliance and technical control validation data to determine and report baseline variance for all applicable technology environments. Interfaces with internal and external audit staff to ensure appropriate and accurate responses to audit queries are satisfied in a timely fashion. Assists in researching and evaluating systems and procedures for the prevention, detection, containment and correction of information security breaches. Assists in advising management and users regarding security procedures and compliance policies. Utilizing technologically advanced software, performs system monitoring evaluations and audits to ensure compliance with the corporate security policies and standards. Prepares and analyzes compliance information to develop mitigation priorities, milestones and audit responses. Participates in the evaluation of products and/or procedures to enhance productivity and effectiveness of information security across the organization.

Assists architects and security specialists to ensure adequate security solutions are in place throughout IT systems and platforms to mitigate identified risks sufficiently, and to meet business objectives and regulatory requirements.

Minimum Experience: 4 years of job related technical experience Minimum Education: Bachelor's degree in Computer Science, Information Technology or other job related degree. or 4 years of job related work experience or 2 years of job related experience plus an associate’s degree in Computer Science, Information Technology or other job related degree

ANALYST, BUSINESS SYSTEMS I

Functional Responsibilities: Elicit and document user requirements to meet a business objective.

Identify and validate requirements and organize the information into a logical document that is understood by the customer and Information Systems. Guide both technical and customer departments in the development of the systems that support the business solution. Ensure the accurate deployment of solutions through review of problem logs, assisting with test plans and test matrices, and other analysis activities. Validate the business need for solutions to business problems and process improvements.

Minimum Experience: 2 years of IT business analysis experience Minimum Education: Bachelor's degree in Computer Science, Business Administration, or other job related field. or 4 years of job related work experience or 2 years of job related experience plus an associate’s degree in Computer Science, Business Administration or other job related degree

ANALYST BUSINESS SYSTEMS II

Functional Responsibilities: Elicit and document user requirements to meet a business objective.

Identify and validate requirements and organize the information into a logical document that is understood by the customer and Information Systems. Guide both technical and customer departments in the development of the systems that support the business solution. Facilitate the transfer of knowledge about the direction of the business units to others who support them. Ensure the accurate deployment of solutions through review of problem logs, assisting with test plans and test matrices, and other analysis activities. Provide input on the business direction for system changes. Validate the business need for solutions to business problems and process improvements. Assist in the development and documentation of training materials. Mentor or train less experienced staff.

Minimum Experience: 4 years of IT business analysis experience.

Minimum Education: Bachelor's degree in Computer Science, Business Administration, or other job related field. or 4 years of job related work experience or 2 years of job related experience plus an associate’s degree in Computer Science, Business Administration or other job related degree.

ANALYST, BUSINESS TEST I

Functional Responsibilities: Prepares and reviews test data and test matrices for system changes.

Develops test matrices to accurately reflect changes and details expected outcome. Executes test cases and evaluates test results for errors. Reports problems through appropriate channels and suggests corrections for a successful implementation. Utilizes internal and external software necessary to support testing and development of skills. Researches and documents system problems and assists in their resolution. Reviews and completes various daily reports to ensure system is performing as expected.

Prepares written reports and analysis, including recommendations pertaining to system functionality.

Utilizes internal and external applications for technical research of system issues. Functions as a liaison between the production operations areas, other area testers and Information Systems to facilitate communications. In addition, assists customers and testers with issues that arise both in production and during testing.

Minimum Experience: 2 years of experience working in related processing support systems.

Minimum Education: High School Diploma or equivalent.

ANALYST, BUSINESS TEST II

Functional Responsibilities: Reviews projects and change sheets. Attends Scope, Design and Test Plan walkthroughs for major system projects. Coordinates testing and debugging of new or modified software. Creates test matrices, trains, and provides supporting documentation. Analyzes technical documentation to create test plan/matrices and updates statistical reporting software. Develops and executes formal test plans using analytical skills to ensure delivery of quality software applications.

Monitors software/ programs implemented to verify that changes to the system’s operational process had the desired effect. During the testing process analyzes the system for exceptions and other items requiring posttest attention. Identifies and documents systems problems and works with Information Systems and the production areas on short term and long term solutions. Defines and evaluates quality assurance metrics such as defects, defect counts, test results, and test status. Analyzes test data for accuracy and status to inform customer whether it will enhance current production operations. Creates defect records based on analysis of test results to correct programming deficiencies. Creates statistical information for Information systems and customers in order to track the progress of implementations.

Prepares reports and analyses pertaining to testing results and/or production issues, including recommendations for customers on improving operational workflows.

Minimum Experience: 2 years of experience working in related processing support systems. 2 years of system testing or system testing development experience.

Minimum Education: High School Diploma or equivalent.

ANALYST, BUSINESS I

Functional Responsibilities: Obtains a detailed understanding of the major operations and functions in effect within the areas being supported. Reviews basic system enhancements/upgrades to determine applicability of customer file modification requirements. Following clearly defined procedures, assists in facilitating timely and accurate updates to reference files based on customer requests. Documents system problems and assists in their resolution. Reviews and completes various daily reports to ensure system is performing as expected. Prepares written reports and analysis, including recommendations pertaining to system functionality and testing progress. Prepares and reviews test data, test plans and test matrices for system changes. Develops test matrices to accurately reflect changes and detail expected outcome. Executes test cases and evaluates test results for errors. Reports problems through appropriate channels and suggests corrections for a successful implementation. Under the guidance of an advanced business analyst or manager, learns to define business requirements, perform tests, and may lead small projects. Learns how to prepare and review data for analysis in order to evaluate the activities, performance and systems within a specific area for standards and workflow simplification.

Communicates with management and departmental personnel to document workflow procedures. Assists in preparing verbal and written communication about business changes with management or other staff members. Functions as liaison between the operations testers and information systems to facilitate communications. In addition, assists customer testers with issues that arise during projects.

Minimum Experience: 0 years Minimum Education: Bachelor's degree or 4 years of job related business experience.

ANALYST, BUSINESS III

Functional Responsibilities: Develops detailed test plans and documents test data based on specifications. Conducts testing and relays results. Guides less senior analysts with testing activities.

Defines and analyzes quality assurance metrics such as defects, counts, test results and status, to ensure work is free of errors. Participates with other areas on special projects and committees to improve testing quality. Works with other areas to update desk procedures impacted by change sheets/projects.

Reviews system enhancements/changes and identifies issues to the standard system and other processing components. Updates and reviews any changes to the reference files. Acts as a facilitator or leader for business/contract mandates and moderate to large projects. Objectively evaluates the activities and systems within specific area for process evaluation and makes recommendations for simplification.

Interviews management and department personnel to reevaluate workflow processes. Maintains accurate documentation for external users. Writes procedures and documents customer requirements. Guides coworkers in problem resolution related to documented procedures as well as various systems and/or connectivity issues. May approve or review recommendations from less senior analysts. Prepares verbal and written communication regarding changes, procedures, projects, implementations, etc. Ensures the communication process between the user and the shared system maintainer (s)is positively maintained and occurs on a frequent basis. Attends designated weekly workgroup calls. Completes necessary reporting for analysis using applicable programming, software, and/or reporting tools.