Healthcare Claims Examiner

We need to output HTML fragment with headings

for sections: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Only include sections that have real specific content. We need to parse the job description. First, remove boilerplate: cookie/navigation/legal/EEO/equal-opportunity/scam-warning, duplicated lines, application instructions. Also remove identity verification process? That might be considered boilerplate? It's about hiring process, maybe keep? It's not a standard section; but it's not required. Might be considered boilerplate? The instruction: Remove cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate, duplicated lines, and application instructions. Identity verification process is not exactly those, but could be considered part of hiring process; but not required to keep. Safer to keep only substantive content about role, responsibilities, qualifications, etc. We need sections: - About the role: likely the paragraph describing GDIT and the role: "General Dynamics Information Technology and CSRA have united...". Also "GDIT is currently seeking a Healthcare Claims Examiner in Raleigh, North Carolina to join our team. In this role you will be a change agent by evaluating the appropriateness of beneficiaries' admission to nursing facilities; evaluating the medical necessity of surgical and medical prior approval request, which may include transplants, out-of-state evaluations and surgeries." That's about the role. - Responsibilities: list bullet points after "RESPONSIBILITIES:" includes several bullet-like sentences. We'll put each as

. - Qualifications: there is a "QUALIFICATIONS:" section with Required Skills and Experience and Desired Skills And Experience. Also there is "Job Qualifications:" earlier with list of skills: Clinical Research, Health Care, Long Term Care (LTC), Medical Surgical Care, Surgeries. That seems like qualifications. Also "Skills:" earlier with list? Actually there is "Skills:" line after Job Family: Ancillary Health Skills: then blank? It says "Skills:" then blank line then "Job Qualifications: Clinical Research, Health Care, Long Term Care (LTC), Medical Surgical Care, Surgeries". So we can treat that as Skills/Qualifications. We need to decide sections: maybe combine Skills and Qualifications? The instruction: use headings for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). So we can have separate sections for Skills and Qualifications if content exists. We have content for Skills: maybe the list "Clinical Research, Health Care, Long Term Care (LTC), Medical Surgical Care, Surgeries". Also maybe "Knowledge of Microsoft Office and Outlook", "Experience with medical documentation and reviews". Those are under Required Skills and Experience. So we can put those under Skills. Qualifications: maybe the required experience: "Requires active North Carolina Registered nurse license or Compact license with at least 2 years of clinical experience in long term care and medical/surgical Knowledge of Microsoft Office and Outlook Experience with medical documentation and reviews 3-5 Years of work experience". Also Desired skills: knowledge of NCTracks, etc. Also Attributes for Success. We could treat Qualifications as the required/desired skills and attributes. We also have Pay: "The likely salary range for this position is $63,118 - $85,394." That's specific, so include Pay section. Schedule: "Scheduled Weekly Hours: 40". Also maybe "Travel Required: None Telecommuting Options: Hybrid Work Location: Any Location / Remote Additional Work Locations:" That's schedule/location info. So we can include Schedule section with weekly hours, travel, telecommuting, work location. Benefits: there is a paragraph about Total Rewards: benefits package details. So include Benefits. Now we need to output HTML fragment only, with

headings and

• for lists,

  for prose. We must not repeat job title as heading. Not include Job ID etc. We must preserve all substantive information; do not invent or summarize away detail. So we need to include all details from the posting that are not boilerplate. Let's extract substantive content: About the role / company description: - "General Dynamics Information Technology and CSRA have united to create the premier provider of high-tech IT solutions to the government IT market. Together as General Dynamics Information Technology, we deliver cost-effective, next-generation IT solutions and services to the Department of Defense, the intelligence community and federal civilian agencies as they modernize their information systems." - "GDIT is currently seeking a Healthcare Claims Examiner in Raleigh, North Carolina to join our team." - "In this role you will be a change agent by evaluating the appropriateness of beneficiaries' admission to nursing facilities; evaluating the medical necessity of surgical and medical prior approval request, which may include transplants, out-of-state evaluations and surgeries." That's about the role. Responsibilities (list): - Verify receipt of documentation that supports the medical necessity of prior approval requests for admission into a long term care facility - Evaluate accuracy and timeliness of documentation submitted for prior approval requests for surgeries and medical care - Meet daily expected performance expectations by completing at least 30 prior approval reviews daily - Meet quality expectations of greater than 95% accuracy on quality assurance reviews - Meet service level agreement of timely reviews by completing the reviews within 24 -72 hours - Meet timely updating of the system with prior approval decisions within 7 business days Qualifications / Skills: Required Skills and Experience: - Requires active North Carolina Registered nurse license or Compact license with at least 2 years of clinical experience in long term care and medical/surgical care - Knowledge of Microsoft Office and Outlook - Experience with medical documentation and reviews - 3-5 Years of work experience Desired Skills And Experience: - Prefer to have knowledge of NCTracks - Prefer to have knowledge of business processes of North Carolina Division of Medicaid - Prefer clinical medical, surgical and nursing facility experience - Prefer clinical research experience Attributes for Success: - Ability to utilize professional knowledge, judgement and skills in the application of Policy guidelines - Ability to analyze processes and contribute to improvements - Comfortable with technology and changes in technology - Strong verbal and written communication skills Also earlier "Job Qualifications: Clinical Research, Health Care, Long Term Care (LTC), Medical Surgical Care, Surgeries". That seems like a list of skill areas. We could combine these under Skills and Qualifications sections. We need to avoid duplication. Let's decide: Section Skills: list of skill areas: Clinical Research, Health Care, Long Term Care (LTC), Medical Surgical Care, Surgeries; Knowledge of Microsoft Office and Outlook; Experience with medical documentation and reviews. Section Qualifications: Required and Desired experience, licenses, years, attributes. But the instruction says we can have both Skills and Qualifications headings if content exists. We'll create:

  Skills

  • Clinical Research
  • Health Care
  • Long Term Care (LTC)
  • Medical Surgical Care
  • Surgeries
  • Knowledge of Microsoft Office and Outlook
  • Experience with medical documentation and reviews

  Qualifications

  • Active North Carolina Registered nurse license or Compact license with at least 2 years of clinical experience in long term care and medical/surgical care
  • 3-5 years of work experience
  • Knowledge of Microsoft Office and Outlook (already listed but okay)
  • Experience with medical documentation and reviews
  • Desired: knowledge of NCTracks
  • Desired: knowledge of business processes of North Carolina Division of Medicaid
  • Desired: clinical medical, surgical and nursing facility experience
  • Desired: clinical research experience
  • Attributes for Success: ability to utilize professional knowledge, judgement and skills in the application of policy guidelines; ability to analyze processes and contribute to improvements; comfortable with technology and changes in technology; strong verbal and written communication skills
  But we might duplicate some items; better to avoid duplication. Perhaps combine required and desired under Qualifications, and Skills just the skill areas. Let's think: Skills section could be the bullet list of skill areas (Clinical Research, Health Care, LTC, Medical Surgical Care, Surgeries). Then Qualifications section includes license, experience, desired knowledge, attributes. We also have "Experience: 3 + years of related experience" earlier in the requisition metadata. That's covered. Now Benefits: paragraph about Total Rewards: list of medical plan options, dental, vision, 401(k), flex work weeks, paid time off, paid leave, holidays, paid family leave, disability, life, AD&D, personal accident, critical illness, business travel accident insurance, etc. We need to preserve all substantive information; we can summarize but not invent. However we must not summarize away detail? The instruction: "Preserve ALL substantive information; do NOT invent or summarize away detail." That suggests we should keep the details, not condense them into vague statements. But we can still use

  to contain the prose as is, maybe trimmed of boilerplate. The benefits paragraph is long; we can keep it as a

  with the sentences. Similarly About the role: we can keep as

  with the sentences. Responsibilities: we need

  • for each duty. Pay: we can put

    The likely salary range for this position is $63,118 - $85,394.

    Schedule: we have "Scheduled Weekly Hours: 40", "Travel Required: None", "Telecommuting Options: Hybrid Work Location: Any Location / Remote", "Additional Work Locations:" (maybe empty). We'll include those as

    or

    . Probably

    with details. We must not include sections with filler like "commensurate with experience". We have actual numbers. Now we need to ensure we removed boilerplate: EEO statements, identity verification process, "About Our Work", "Join our Talent Community", etc. Also remove duplicated lines like "General Dynamics Information Technology and CSRA have united..." appears only once. Also remove "As a trusted systems integrator for more than 50 years..." paragraph (that's boilerplate about company). That is likely considered boilerplate? It's about company but not specific to role; might be considered boilerplate. The instruction: Remove cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate, duplicated lines, and application instructions. The company overview might be considered boilerplate but not explicitly listed. However it's not specific to the role; but it's substantive about the company. The instruction says preserve ALL substantive information; do NOT invent or summarize away detail. The company overview is substantive but maybe considered boilerplate? It's not legal/EEO. It's about the company. I'd keep it in About the role? Actually we already have a paragraph about GDIT being premier provider etc. The later paragraph about being a trusted systems integrator for more than 50 years is additional company info. Could keep as part of About the role. But to be safe, we can include it as part of About the role. But we must not include "Equal Opportunity Employer / Individuals with Disabilities / Protected Veterans" etc. That's EEO boilerplate; remove. Also remove "Our Identity Verification Process:" etc. That's not EEO but maybe considered hiring process; not explicitly prohibited but could be considered boilerplate? It's about hiring process; not required to keep. Safer to remove. Also remove "About Our Work:" paragraph. Also remove "Join our Talent Community..." etc. Also remove "Total Rewards At GDIT:" heading? We'll keep benefits but maybe strip the heading. We need to output only HTML fragment. Let's craft:

    About the role

    General Dynamics Information Technology and CSRA have united to create the premier provider of high-tech IT solutions to the government IT market. Together as General Dynamics Information Technology, we deliver cost-effective, next-generation IT solutions and services