Claims Trainer

About the role

The Claims Trainer at Kern Health Systems is responsible for the direct training of the Claim Examiner staff. Key responsibilities include reviewing Claims policy and procedures to ensure staff compliance, working with Claims supervisory staff to identify and correct trends in staff claims processing errors, and facilitating classroom style training for new hires.

• Review Claims policy and procedures to ensure staff compliance
• Identify and correct trends in staff claims processing errors
• Develop and maintain a training program for all new claims processors
• Provide ongoing training of new staff and audit claims throughout the training phase
• Develop, maintain and organize a training program for all existing functions within the Claims Department
• Periodically train experienced staff on new procedures and changes
• Aid in the implementation and User Acceptance Testing of new system programs
• Maintain confidentiality of staff deficiencies requiring additional training
• Support Claims Management in process improvement
• Conduct periodic audits and reviews to ensure compliance with policies, plans, procedures, and performance standards
• 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 using various commercial software systems and specialized department systems
• Develop new claims guidelines for all claim types and ensure existing guidelines are kept current
• Train new and existing employees on internal findings of deficiencies
• Maintain an effective, efficient, and confidential filing system for department information
• Perform other job-related duties as required

Requirements

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.

Qualifications

• 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