Claims Trainer
Claims Trainer
Posted on :
21-04-2025
Employer Active
1 Vacancy
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Job Description
Curative is searching for a Claims Trainer to review claims for completeness and process per plan guidelines as well as work on detailed projects and audits for all lines of business as assigned. Carries out all duties while maintaining compliance and confidentiality and promoting the mission of the organization..
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Provides training of department procedures and workflows to new hires and ongoing training and
development for all Claim Analyst/SAU staff - Provides new hire orientation and training on claim related systems and processes to other operations
staff. - Develops topic specific training modules for the use of new hire training and development of existing
staff. - Maintains thorough understanding of all plans offered by Curative and how to process those benefits
accordingly. - Provides realtime guidance to onsite and remote Claim Analysts/SAU staff regarding claim adjudication
and benefit questions and issues both verbally and in writing as needed. - Collaborates with department management to maintain updated department Policies and Procedures (P
& Ps) Processing Guidelines and training material. - Collaborates with Claims Quality/Training department to leverage audit results for staff development.
- Understands benefit plans for all clients with the ability to process claims in accordance with the client
benefits and procedures. - Participates in system testing as needed.
- Identifies quality and/or productivity issues and provides recommendations to department management
for improvements. - Assist management in establishing ongoing improved processes and system efficiencies.
- Effective email management and prioritization of daily work assignments.
- Special projects as assigned.
- Understands and can process claims for all client benefit plans in accordance with the benefits and
Policies and Procedures. Participate in system testing as needed. - Identifies quality and/or productivity issues and provides recommendations to department management
for improvements. - Provides review and mentoring for other SAU Analysts and Claims department.
- Performs other duties functions and projects as assigned by team management.
REQUIRED EXPERIENCE
- At least 3 years of experience in claims benefit review/ adjudication including PPO and/or Medicaid. Experience with various claim payment systems in processing hospital mental health dental and routine medical claims within given deadlines.
- Experience working on/ with the VBA/HRP claims system would be extremely beneficial in this role
- At least 3 years Auditing experience
- Knowledge of medical terminology ICD10 CPT and HCPCS coding TDI and CMS regulations and
multi states regulation/ audit experience would be beneficial - Working Knowledge of MS Access and Excel preferred
- Excellent computer and keyboarding skills including familiarity with Windows
- Excellent interpersonal & problemsolving skills.
- Excellent verbal and written communication skills to communicate clearly and effectively to all levels of staff members and providers.
- Ability to be detail oriented focused and sit for extended periods of time at a computer workstation.
- Ability to work in a team environment and manage competing priorities
- Ability to calculate allowable amounts such as discounts interest and percentages
REQUIRED EDUCATION LICENSES and/or CERTIFICATIONS
- High school diploma or equivalent.
Required Experience:
IC
Employment Type
Full-Time
Key Skills
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