Claims Trainer

Centers Plan for Healthy Living's goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision makers, and general caregivers with the guidance and plans they need for healthy living.

JOB SUMMARY

The Claims Trainer is responsible for planning, developing and delivering training programs that meet specific needs for the Claims Department. The trainer will collaborate with the claims management team to identify and analyze learning gaps and opportunities to facilitate staff development and promote continued high performance.
 

PRIMARY RESPONSIBILITIES

• Designs, develops, and implements training programs, material and curriculum that identify learning and educational needs of the department.
• Delivers training through one-on-one sessions, new hire onboarding, mentoring, classroom presentations, workshops to ensure consistency and compliance throughout department.
• Identifies learning gaps and opportunities in collaboration with the claims Quality team and the Claims Integrity Department.
• Based on identified learning gaps develops training strategies and priorities to achieve improvement.
• Develops Performance Improvement Plan in collaboration with claims management and the Quality team as needed.
• Works with other departments to provide training on the claim application.
• Works will all levels of claims management to develop workflows and policies
• Conducts testing of the claim system with regard to configuration changes, new product implementations and annual testing.

EDUCATION:

• Bachelor’s degree preferred.

EXPERIENCE:

• 1-3 years of training and development experience preferred.
• 1-3 years of claim handling experience required

KNOWLEDGE and SKILLS

• Must possess a sound working knowledge of industry claim procedures and understand the lifecycle of a claim.
• Must have excellent presentation skills.
• Strong written and verbal communication skills are essential.
• Must possess an understanding of ICD10, CPT and HCPCS coding
• Knowledge of Medicare payment methodology such as DRG and APC
• Strong facilitation and development skills preferred.
• Must be organized and detailed oriented.
• Proficient in computer skills a must (Word, Excel, Access and PowerPoint, e-Learning tools)

Travel to other claim processing sites is required. 

Centers Plan For Healthy Living is committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our employees and our business. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law and will not be denied employment.