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#18-004395-0021
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. Applications that do not include a completed supplemental questionnaire will be considered incomplete and may be subject to disapproval.**

 


1

Describe your experience applying policies in a medical care, health insurance or federal or State entitlement program.  This experience must also be included on your application.  If you do not possess this type of experience, please indicate N/A in the text box.

2

Describe your knowledge of Medicaid Services and professional interaction with services providers.

Please include name of employer, job title, dates of employment, and hours worked per week, this information must also be reflected in your application.  If you do not possess experience in this area, put N/A in the box below.

3

Describe your experience of programs and services available to clients requesting medical assistance (i.e. Commission on Aging, DSS, TCA, Food Stamps, Reach, etc.).  This experience must also be included on your application.  If you do not possess this type of experience, please indicate N/A in the text box.

4

Describe your experience with the CARES, MMIS and HBX systems. 

Please include name of employer, job title, dates of employment, and hours worked per week, this information must also be reflected in your application.  If you do not possess experience in this area, put N/A in the box below.

5

Describe your customer service skills within an office setting (i.e., dealing with internal and external customers by phone or in person).  This experience must also be included on your application.  If you do not possess this type of experience, please indicate N/A in the text box.

6

Bilingual applicants are encouraged to apply.

Are you able to speak, read and write in both English and another language?

Yes No

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