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#19-006659-0001
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 working with a State Based Marketplace or in Healthcare. Include the name and dates of the employer. If you do not possess this type of experience, please enter N/A.

2.

Describe your experience working with Electronic Data Interchange (EDI) 834 files. Include the name and dates of the employer. If you do not possess this type of experience, please enter N/A.

3.

Describe your experience leading a team in a professional environment.  Iinclude the name and dates of the employer. If you do not possess this type of experience, please enter N/A. 


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