Operations Trainer (Remote)

ABOUT EVRY HEALTH Evry Health is a next-generation health plan built on the belief that healthcare should be simple, transparent, and centered around the member. We combine cutting-edge technology with compassionate, high-touch service to deliver a health plan experience that truly works for employers and their employees. Our team is mission-driven, collaborative, and committed to removing the complexity that too often stands between people and the care they need. POSITION SUMMARY The Remote Virtual Claims & Customer Service (Operations) Trainer is responsible for designing, delivering, and continuously improving training programs that equip Evry Health's contact-center and claims operations staff with the knowledge, tools, and confidence needed to perform at the highest level. Operating fully in a remote environment, this role supports new-hire onboarding, ongoing skill development, system proficiency, and regulatory compliance training across both claims processing and customer service functions. The ideal candidate is an engaging virtual facilitator with deep operational expertise in health plan administration and a talent for translating complex processes into clear, actionable learning experiences. Roles & Responsibilities Training Delivery & Facilitation Virtual Facilitation: Deliver engaging, interactive training sessions via Teams platform for new hires and tenured staff covering product knowledge, soft skills, and systems navigation. New-Hire Onboarding: Lead structured onboarding programs covering Evry Health’s products, systems, workflows, policies, and member‑centric service standards. Role‑Play & Simulation: Design and facilitate live role‑play scenarios that mirror real customer interactions, claims inquiries, and escalation situations. Blended Learning: Combine synchronous instructor‑led sessions with asynchronous e‑learning modules, job aids, and recorded content. Competency Verification: Administer knowledge checks, quizzes, and skills assessments to confirm learner readiness before live deployment. Post‑Training Monitoring: Monitor staff performance; identify training gaps and deploy targeted interventions to address deficiencies quickly. Change Communication Support: Collaborate with Operations leadership to craft clear, timely change communications that prepare agents for upcoming system or workflow transitions. Claims Operations Training Claims Processing Fundamentals: Train staff on end‑to‑end claims lifecycle, adjudication, issue identification and remediation, including testing outcomes, denial, adjustment, and dispute procedures. Regulatory Compliance: Deliver training on Texas Insurance Code Chapter 1467, prompt‑pay requirements, IDR processes, and CMS guidelines. Coding & Billing Basics: Provide foundational instruction on ICD‑10, CPT, HCPCS, and modifier usage as it relates to claims review and provider disputes. Dispute & Appeal Workflows: Train staff on internal and external dispute resolution processes, timelines, and documentation requirements. Customer Service Operations Training Contact Center Standards: Train agents on Evry Health’s call‑handling protocols and quality expectations. Member & Provider Communication: Coach staff on professional, empathetic communication. Correspondence Turnaround: Reinforce 1‑business‑day (member) and 2‑business‑day (provider) correspondence turnaround standards and documentation requirements. Escalation Handling: Build staff confidence in identifying, documenting, and escalating complex or sensitive cases to supervisory and clinical teams. Quality Assurance Alignment: Align training content with QA audit rubrics covering call quality, case accuracy, and documentation standards. Curriculum Development & Content Management Training Material Creation: Develop and maintain SOPs, job aids, desktop procedures, e‑learning modules, and quick‑reference guides for all operational workflows. Knowledge‑Check Design: Build comprehensive knowledge assessments with scoring rubrics aligned to benefit program content and operational standards. Content Updates: Promptly revise training materials in response to regulatory changes, system updates, or operational policy revisions. Learning Management Administration: Upload, organize, and track training completion records. Reporting & Analytics: Generate training completion reports, assessment score summaries, and gap‑analysis data for Operations leadership. SME Collaboration & Curriculum Development: Partner with subject matter experts across Claims and Customer Service Operations to capture process knowledge, workflow nuances, and performance expectations, then translate that expertise into role‑specific curriculum with the level of detail required for staff to accurately and confidently perform their job functions. Documentation Standardization: Review and restructure existing Desktop Procedures (DTPs) and current operational documentation, consolidating and reformatting content into a consistent, standardized format aligned with Operations’ style and readability requirements. Experience & Skills Desired Required Education: Bachelor’s degree in Business, Healthcare Administration, Education, Communication, or a related field; or equivalent work experience. Experience: 3–5 years of experience in health plan operations (claims and/or customer service); minimum 2-4 years in a training, coaching, or instructional role. Strong preference for background in operations and contact centers. Claims Knowledge: Working knowledge of claims adjudication, appeals/grievances, EOBs, ICD‑10/CPT coding. Texas Insurance Code knowledge is a plus. Customer Service Skills: Demonstrated expertise in contact‑center operations including call quality, and member/provider communication standards (both verbal and written). Virtual Facilitation: Proven ability to engage and manage remote audiences via Zoom, Microsoft Teams, or equivalent video‑conferencing platforms. System Proficiency: Experience with Salesforce, Vonage, and/or comparable CRM, telephony, and health plan platforms. Communication: Exceptional written and verbal communication skills; ability to translate complex regulatory and clinical content into plain‑language training. Organization: Strong project‑management skills with the ability to manage multiple training cohorts, deadlines, and content‑revision cycles simultaneously. Preferred Certification in instructional design, adult learning (CPLP, ATD), or a related credential. Experience with e‑learning authoring tools such as Articulate 360, Rise, or Adobe Captivate. Familiarity with CMS Star Ratings, NCQA, or URAC accreditation standards. Prior experience supporting UAT, system rollouts, or technology implementation projects. Background in employer‑sponsored health plan administration/Commercial health insurance. Experience building and administering knowledge‑check assessments with scoring rubrics. Work Environment Setting: Fully remote; home office with reliable high‑speed internet required. Schedule: Core hours align with CST/EST business hours. Equipment: Evry Health‑issued laptop, headset, and collaboration tools provided. Physical Demands: Prolonged periods of sitting and working at a computer; virtual facilitation for extended sessions. Collaboration: Daily interaction with Operations leadership, HR, IT, and vendor partners via virtual channels. $65,000 - $68,000 a year #J-18808-Ljbffr