Trainer - Sacramento, CA 

Develops and conducts training programs, orientation, and
continuing education for new and current employees in the Claims Department. Schedule, coordinate and communicate training activities to Claims Management Team. The Claims Trainer provides the initial detailed training, as well as remedial/refresher training as needed for the Claims Department. The Claims Trainer must teach claims staff to make logical benefit decisions to process claims utilizing appropriate pricers, internal fee schedules, and a variety of other programs and screens. This position also identifies opportunities to enhance the skills and competency of the claims staff. The incumbent assesses training needs of staff and monitors the effectiveness of the training program.

RESPONSIBILITIES:

• Directs training of PDM/Configuration associates in various modalities: classroom, small groups and individual mentoring.
• Design, plan and implement claims training program:
• Develop training materials for use in class; e.g., visual aids, templates, flow charts, and screen printouts.
• Identifies training, developmental and support needs by conducting departmental analyses.
• Conduct training for newly hired team members on core systems, processes, and applications
• Educate team members on the appropriate usage of internal reference material.
• Evaluate and communicate individual performance.
• Develop and implement learner reviews upon completion of each training module.
• Maintain statistics on individual employee performance during the course of training.
• Develop and motivate team members to achieve their highest potential, and act as a mentor for all team members during the training program.
• Audits to ensure accurate claims adjudication.
• Communicates payment methodology inconsistencies to management; researches CPT code rates and updates as appropriate.
• Trouble shoots potential system problems and provides feedback to the claims management team.
• Create and performs in-service training sessions to various departments within the organization when information is necessary to understand the claims process.
• Operates as a team player to ensure open communication and establishes trust that supports a team environment in the classroom and within the units.
• Update existing curriculum ahead of learning events including gathering of examples, activities, etc.
• Secure room / facility resources as necessary to provide for successful training
• Create new / validate existing lesson plans with Managers
• Develop ad hoc training as needed
• Deliver continuing education, up skill, and performance improvement training as necessary
• Works with Claims and Training Manager on implementing strategic direction of Training organization
• Performs other job duties as assigned

EDUCATIONAL REQUIREMENTS:

• High School Diploma or GED
• College degree required (or equivalent relevant experience).

QUALIFICATIONS AND EXPERIENCE:

• Minimum 3 years training/teaching experience in a professional setting with demonstrated capacity to design training and performance improvement programs
• Excellent verbal and written communication skills
• Minimum of 3 years training medical claims processing experience and a solid understanding of industry standard claims processing methodologies preferred.
• Experience in health care industry. Prefer previous experience in an IPA or health plan setting.
• Strong knowledge of medical terminology and/or ICD-9/ICD-10 coding knowledge.
• Requires a strong technical knowledge and understanding of HMO policies and regulations.
• Requires excellent verbal and written communication skills with an emphasis in creating a dynamic training presentation, diagrams, instructions, checklists, and illustrations.
• Requires flexibility.
• Knowledge and experience in Instructional Design preferred.

Required experience:

• Training: 3 years

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