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#17-002247-0040
Supplemental Questionnaire

Last Name
First Name

 

***Please note that your answers on the supplemental questionnaire must correspond to the information provided on your application to receive credit.***


1

Describe your professional experience working with the Medicaid program. In your response, please include the name of employer, job title, dates of employment, and hours worked per week for each relevant position.  If you do not have this experience, put N/A in the box below.

2

Please describe your experience with the following systems or  closely related systems: MMIS/Medicaid Management Information Systems, HBX/Health Benefits Exchange, Salesforce and CARES/Client Automatic Resource Eligibility Systems.  If you do not have this type of experience, please write N/A.

3

Please describe your professional experience corresponding with Legislators and customer advocacy groups. In your description, please include the job duties performed, name(s) of employer(s), and dates of employment. If you do not have this type of experience, please write N/A.

4.

Please describe your professional experience working with Qualified Health Plans.  In your response, please include the job duties performed, name(s) of employer(s) and dates of employment. If you do not have this type of experience, please write N/A.

5.

Do you have experience in dealing with the public and providing customer service? Is so, please describe your experience and where you gained this experience.  If you do not have this type of experience, please write N/A.


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