Senior Claims Trainer and Technical Specialist

HealthPartners • Bloomington, MN

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About The Position

HealthPartners is hiring a Senior Claims Trainer and Technical Specialist to join our Riverview Claims Department. The Claims Senior Trainer and Technical Specialist develops, implements, trains and supports the administration the HealthPartners products claims process. This position focuses on the training program, along with expedient and accurate adjudication of claims. To provide the direction, guidance and support necessary to bring about individual development in line with individual needs and department objectives. Serves as the primary technical resource for claims, provides input to department systems, recommends, coordinates and implements system changes. Serves as a project leader in the use, development, implementation and enhancement of systems and coordinates the activities of all affected areas. Training and Resources Activities: Provides expertise in training for new and existing employees of system functionality including all modules of the claims system and DEC applications. Formulate training sessions based on department needs including but not limited to: systems, products, compliance requirements and member and provider experience. Develop staff technical competence to ensure maximum production and quality standards. Design and revise procedures as necessary to facilitate claim processes are as efficient as possible. Train employees across employee hierarchy (front line to leadership) to assist in the development of knowledge, skills and abilities. Coaches and mentors to department trainers. In partnership with leadership, address performance issues with claim staff, providing input on development and training needs for employee specific scenarios. Create and develop departmental and interdepartmental policies & procedures and resources to support Claims and other departments as needed. Analyze other department and corporate information for inclusion in department resources. System Support Activities Develop and recommend potential system enhancements and modifications of Claim applications and other health plan systems. Assist with testing system enhancements and modifications of Claim applications and other health plan systems. Work with the Claim Benefit team to coordinate Claim benefit set up for administered products. Audit benefit set-up within the claim system to ensure accurate adjudication of claim. Assists Claim staff and other Riverview (HealthPartners) departments as the primary technical resource regarding questions/problems related to the use of Claim and Health plan system applications and their processes. Identify potential improvements in automated or manual processes; suggest changes to improve processes, update user documentation and operational procedures including enhancements in auto adjudication rates. Works with Claims Leadership team to implement enhancements and manage change. Designs and revises procedures as necessary to facilitate and make claims processing as efficient as possible. Additional Accountabilities: Actively participate in cross-functional initiatives, projects, and reoccurring inter-departmental meetings. Appling experience and expertise to ensure claims experience meets HealthPartners expectations. Participate in business continuity planning and implementation. Actively participates in the preparations for regulatory audits, including universe and file submissions, documentation requirements and presentations to compliance regulators. Perform other duties and projects as assigned by supervisor, manager, or director. Supports departmental and divisional teams through participation and appropriate meetings and projects. Support includes coordination of all processes affected by a project to capture complete information for appropriate training documentation and implementations. Interacts with other supervisors and personnel from other department or organizations to resolve mutual problems. Participates in departmental planning and redesign.

Requirements

• Bachelor’s degree in a related field.
• Four years managed care or insurance product/benefit experience.
• Previous training experience.
• Experience with and technical understanding of HealthPartners Systems including; HCSS, PROD, Surround Letter System, CORS and Microsoft Office.
• Knowledge of the health care industry, including customer expectations on service
• Experience in interpreting and adhering to Government regulations as it applies to claims processing
• Excellent written communication skills and ability to develop and customize training curriculum, create policies and procedures, business requirements, system requirements
• Excellent oral communication and presentation skills and ability to lead group discussions
• Advanced analytical and problem-solving skills
• Demonstrated leadership skills and ability to accept or delegate responsibility
• Ability to handle multiple projects and tasks/assignments and to manage priorities to meet weekly and monthly team goals and corporate initiative deadlines.
• Strong knowledge of HealthPartners products, policies, and procedures.

Nice To Haves

• Training experience
• Working knowledge of HealthPartners claims processing systems
• Working knowledge of reporting programs
• Advanced HealthPartners operational experience.
• Previous project management experience
• Knowledge of on-line learning tools and training
• College coursework in computer science
• Thorough knowledge of HealthPartners’ member and provider contracts.
• Working knowledge of HealthPartners’ processing system.
• Experience with systems/application analysis and testing

Responsibilities

• Provides expertise in training for new and existing employees of system functionality including all modules of the claims system and DEC applications.
• Formulate training sessions based on department needs including but not limited to: systems, products, compliance requirements and member and provider experience.
• Develop staff technical competence to ensure maximum production and quality standards.
• Design and revise procedures as necessary to facilitate claim processes are as efficient as possible.
• Train employees across employee hierarchy (front line to leadership) to assist in the development of knowledge, skills and abilities.
• Coaches and mentors to department trainers.
• In partnership with leadership, address performance issues with claim staff, providing input on development and training needs for employee specific scenarios.
• Create and develop departmental and interdepartmental policies & procedures and resources to support Claims and other departments as needed.
• Analyze other department and corporate information for inclusion in department resources.
• Develop and recommend potential system enhancements and modifications of Claim applications and other health plan systems.
• Assist with testing system enhancements and modifications of Claim applications and other health plan systems.
• Work with the Claim Benefit team to coordinate Claim benefit set up for administered products.
• Audit benefit set-up within the claim system to ensure accurate adjudication of claim.
• Assists Claim staff and other Riverview (HealthPartners) departments as the primary technical resource regarding questions/problems related to the use of Claim and Health plan system applications and their processes.
• Identify potential improvements in automated or manual processes; suggest changes to improve processes, update user documentation and operational procedures including enhancements in auto adjudication rates.
• Works with Claims Leadership team to implement enhancements and manage change.
• Designs and revises procedures as necessary to facilitate and make claims processing as efficient as possible.
• Actively participate in cross-functional initiatives, projects, and reoccurring inter-departmental meetings.
• Appling experience and expertise to ensure claims experience meets HealthPartners expectations.
• Participate in business continuity planning and implementation.
• Actively participates in the preparations for regulatory audits, including universe and file submissions, documentation requirements and presentations to compliance regulators.
• Perform other duties and projects as assigned by supervisor, manager, or director.
• Supports departmental and divisional teams through participation and appropriate meetings and projects. Support includes coordination of all processes affected by a project to capture complete information for appropriate training documentation and implementations.
• Interacts with other supervisors and personnel from other department or organizations to resolve mutual problems.
• Participates in departmental planning and redesign.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level