Claims Operations Trainer

SUMMARY
Curative is a trusted leader in the healthcare insurance industry delivering innovative solutions and exceptional service to our members. As a fast-growing organization we are building a culture of operational excellence compliance and continuous learning across our claims operations. The Claims Operations Trainer & Documentation Specialist will be responsible for designing delivering and optimizing training programs for our Claims Operations teams while creating and maintaining clear compliant process documentation. This role requires hands-on experience with HealthEdge (HealthRules Payor) and offers the unique opportunity to help scale and optimize this modern claims platform to drive efficiency consistency and high-quality service.

This is a preferred on-site hybrid position located in Austin Texas. We can consider remote position with travel
for the right candidate.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Training Design & Delivery

• Design develop and deliver comprehensive onboarding and continuous training programs for claims staff
  using secure virtual platforms.
• Facilitate engaging training sessions leveraging a variety of formats such as instructor-led eLearning microlearning and self-paced resources.
• Develop training materials and reference guides specific to HealthEdge (HealthRules Payer) system workflows functionality and updates.
• Coach and mentor team members to reinforce learning close skill gaps and support professional development.
  Process Documentation & Knowledge Management
• Create maintain and optimize standard operating procedures (SOPs) job aids process maps and training manuals.
• Ensure all documentation is clear up to date and compliant with CMS state and federal regulations.
• Develop multimedia content including visuals and video tutorials to support diverse learning styles and improve accessibility.

Performance & Quality Monitoring

• Analyze production metrics and quality data to identify training needs and measure effectiveness.
• Track training completion knowledge retention and impact on performance and claims accuracy.
• Report on training outcomes and recommend improvements based on data insights.

Cross-Functional Collaboration & Change Management

• Serve as a HealthEdge subject matter expert and partner with Operations Compliance IT and Quality
  to align training and documentation with evolving processes and regulations.
• Support the rollout of system enhancements process changes and new products by developing targeted training and communication plans.
• Champion a culture of continuous learning operational excellence and compliance across the claims department.

QUALIFICATIONS

To perform this job successfully an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:

• Direct hands-on experience working with HealthEdge (HealthRules Payor) in claims processing configuration or training capacity.
• 3 years of experience in health insurance claims processing and/or training roles.
• Strong knowledge of claims adjudication workflows systems and regulatory requirements (Medicare Medicaid commercial).
• Proficiency in Google Workspace (Docs Slides Sheets); familiarity with LMS platforms knowledge management tools or secure content management systems.
• Proven ability to design and deliver training content in a variety of formats including secure virtual environments.
• Exceptional written and verbal communication skills.
• Demonstrated understanding of HIPAA Privacy and Security Rules and ability to maintain confidentiality
  of Protected Health Information.
• Familiarity with CMS state and federal guidelines governing claims processing and documentation.
• Experience applying adult learning principles and instructional design methodologies.
• Strong organizational skills and the ability to manage multiple priorities in a fast-paced fully remote environment.
• Experience using data and performance metrics to evaluate training effectiveness and inform continuous improvement.
• High degree of initiative self-direction and accountability.

Preferred Skills:

• Experience working with HealthEdge (HealthRules Payor) in claims processing configuration or training capacity.
• Knowledge of CMS and state regulatory guidelines for claims processing.
• Demonstrated proficiency in adult learning principles or instructional design.
• Experience training distributed or remote teams.
• Ability to create visuals and process maps with tools like Lucidchart Visio or Canva.

EDUCATION and/or EXPERIENCE

• Associate or Bachelors degree in Healthcare Administration Education Business or a related field or equivalent experience.
• 3-5 years of health insurance claims training experience (hospital facility professional and behavioral health claims).
• Demonstrated experience teaching within complex claims environments including configuration and benefit interpretation.
• Knowledge of CPT HCPCS ICD-10 revenue codes and medical terminology.
• In-depth understanding of state prompt payment regulations and federal healthcare laws (HIPAA ACA CMS).
• Proven ability to prepare detailed audit reports and present findings to senior leadership.
• Excellent interpersonal and written communication skills with the ability to work collaboratively across teams and effectively manage competing priorities.
• Success metrics include:
  • Ramp-up time to proficiency for new hires.
  • Improvement in claims accuracy and reduction of error rates.
  • Training completion and satisfaction scores.
  • Timeliness and audit-readiness of documentation.

WORK ENVIRONMENT

• While performing the duties of this Job the employee is regularly required to sit; use hands to handle or feel; talk; and hear.
• Specific vision abilities required by this job include close vision distance vision color vision peripheral vision depth perception and ability to adjust focus.
• The noise level in the work environment is usually: Mild
• For this position the percentage of expected Travel is: 15 % of the time