Claims Trainer

Job Overview:

The Claims Trainer will assess departmental training needs, then develop, deliver, and implement new hire and continued educational training for Claims Processors and other Claims Staff employees. The Claims Trainer is also responsible for coordinating with department leaders to document and implement new/updated processes and procedures.

Essential Functions

• Maintains current knowledge of organizational systems, products, vendors, service model, and other pertinent changes related to the member experience that may drive training needs.
• Develops training topics, agenda items, and materials to be used in group, virtual, and one-on-one training sessions.
• Maintains records of completed new hire onboarding and regularly scheduled staff meetings/training.
• Create a complete written training plan/outline for new hires, including timelines.
• Executes new hire and on-going employee departmental training in workshop, group, virtual, and one-on-one sessions, as well as providing weekly updates on all new hires.
• Troubleshoot system issues and work directly with Operations Support Specialist as needed to resolve these issues and make sure any needed system updates are done.
• Research topics and create Salesforce Knowledge documents as well as maintain Salesforce Knowledge articles.
• Coordinates with department leaders to document and implement new/updated processes and procedures in Salesforce Knowledge articles.
• Coordinates with department leadership to assess and execute ongoing departmental training needs, including working directly with the Claims Auditor to pinpoint training needs based on audit findings (results?).
• Assesses staffs learning performance; identifies and provides additional, specialized, or adaptive instruction.
• Assists with the processing of VIP claims, calls and appeals.
• Provides back-up for Claims Auditor as needed.
• Other duties as assigned

Education

• Associates/Bachelor’s degree or equivalent work history.

Experience

• Minimum 3 year of claims processing experience required.
• Minimum 5 years of claims experience with insurance companies or TPA or other healthcare environment
• Experience related to claim adjustments and calculations required.
• Prior experience with claims processing systems required.
• 2 - 3 years of training experience preferred.
• Previous management experience is a plus but not required.
• Dental processing experience is a plus but not required.

Specialized skills/technical knowledge

• Must have experience with and understanding of all aspects of claim processing including but not limited to COB including Medicare, ACA requirements, No Surprises Act, and Mental Health Parity.
• Thorough understanding of medical terminology, medical policy statements, medical records, healthcare coding systems and methodologies such as CPT, HCPCS, ICD-10 and DRG.
• Ability to interpret plan documents to verify whether services are eligible based on the documents.
• Able to review responses from vendors to make sure that the vendors are following our plan guidelines.
• Knowledge of ISSI (Bridgeway) or similar claim processing systems.
• Proficient in MS Office Suite applications including Word, PowerPoint and Excel.
• Excellent math skills
• Must be self-motivated and an independent decision-maker while maintaining an open mind and an ability to be flexible in tough situations.
• Must have excellent communication (written, verbal, listening), organizational, and problem-solving skills.
• Must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone.
• Ability to provide and receive constructive feedback on results
• Ability to adhere to HR, safety, HIPAA and compliance policies and attendance requirements.
• Ability to handle multiple tasks in a fast-paced environment.
• Ability to work independently and meet deadlines.
• Ability to be detail oriented.
• Ability to deal with stressful situations and resolve conflict.

Job Type: Full-time

Pay: $62,500.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Parental leave
• Professional development assistance
• Retirement plan
• Vision insurance

Physical setting:

• Office

Schedule:

• 8 hour shift
• Monday to Friday

Ability to commute/relocate:

• Countryside, IL 60525: Reliably commute or planning to relocate before starting work (Required)

Experience:

• Microsoft Office: 3 years (Preferred)
• Customer service: 3 years (Preferred)

Work Location: In person

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