Claims Trainer

Claims Trainer

We appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will help us potentially place you in a position that meets your objectives and those of the organization. Qualified applicants are considered for positions without regard to race, color, religion, sex (including pregnancy, childbirth and breastfeeding, or any related medical conditions), national origin, ancestry, age, marital or veteran status, sexual orientation, gender identity, genetic information, gender expression, military status, or the presence of a non-job related medical condition or disability (mental or physical).

Work Location: Hybrid/Onsite

Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system.

About the Role

Under limited supervision, the Claims Trainer will report to the Senior Director of Claims. The Claims Trainer is responsible for the direct training of the Claim Examiner staff. Responsibilities include, but are not limited to, review of Claims policy and procedures to ensure staff compliance. This position is responsible for working with the Claims supervisory staff to identify and correct trends in staff claims processing errors.

The Trainer will report audit findings and staff training issues to Claims management for review, along with recommending additional training opportunities that can be used in possible corrective action plans as well as prepare and review recurring Claims departmental, operational data and reports. The Trainer will develop recommendations for process improvement and assist with the action plans for making those corrections. Facilitate classroom style training for new hires that would include a curriculum and testing, as well as one-on-one training and monitoring of results within the department setting. The Trainer will develop training materials and documents, including, but not limited to, desktop guidelines, and will be responsible for its upkeep and maintenance.

The ability to develop effective training materials and strong presentation skills in support of adult learning are critical. Collaboration with other departments and interaction with regulatory and contracted agencies are essential to ensure accurate and comprehensive reporting of Claims Department activities. This position will provide new hire and existing staff with adequate and ongoing training to identify and reduce inaccurate information to callers and processing errors and prepare them for progressive promotions. This position requires the incumbent to have the ability to work with and understand the processes of the Claims Department and to possess interpersonal skills that will facilitate successful training of staff. An understanding of the requirements of healthcare under a Knox-Keene licensed health maintenance organization (HMO) is required.

Essential Duties and Responsibilities

• Develop, maintain and organize a training program for all new claims processors. Provide ongoing training of new staff and audit claims throughout the training phase until the required quantity and quality requirements are met.
• Develop, maintain and organize a training program for all existing functions within the Claims Department
• Provide periodic claims training of experienced staff when new procedures are introduced, work assignments change, staff deficiencies are identified, or promotion of staff occurs.
• Assist with and provide SME input during implementation of new system programs used in the Claims Department as well as assist in User Acceptance Testing of all system program changes prior to production release in order to train staff thoroughly and efficiently.
• Maintains the confidentiality of staff deficiencies that are identified and require additional training.
• Provide direct support to Claims Management in support of process improvement within the Claims Department.
• Conduct periodic audits and reviews to ensure compliance with established policies, plans, procedures, and performance standards within the Claims Department
• Assist in the development and maintenance of productive relationships with all levels of staff.
• Oversee, guide, assist and follow up with coaching staff regarding on-the-job training
• Monitor assigned special projects and reports as required.
• Operate a desktop computer, employing various commercial software systems, and specialized department systems to accomplish data input, manipulation and output.
• Development of new claims guidelines for all claim types and ensuring existing claims guidelines are kept current.
• Develop and implement staff training for new and existing employees that addresses internal findings of deficiencies
• Maintain an effective, efficient, and confidential filing system both manual and electronic to allow easy retrieval and re-filing of department information
• Assist in miscellaneous duties as assigned by management and executives.
• Ability to demonstrate good judgment in following established program procedures
• Ability to adjust to shifting priorities and meet stated deadlines
• Ability to communicate effectively, both orally and in writing
• Maintain productivity and quality in accordance with established guidelines.
• Perform other job-related duties as required.
• Adheres to all company policies and procedures related to employment and job responsibilities.
• Maintain regular predictable attendance

Education and Experience:

• High School Diploma from an accredited school or equivalent.
• Minimum of 4 years of direct experience in processing medical claims. Experience in processing all claim types required.

Pay range shown reflects the full range for this position. Initial offers are typically positioned between the minimum and midpoint, based on qualifications and internal equity.

Pay Range: Minimum: $28.62 Mid-Point: $36.49 Maximum: $44.36

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis.