Claim Department Trainer - Virtual

Position Summary

Use independent judgment and knowledge to determine training needs and perform all aspects of training for the Claim Department. Training will include policies, procedures and system training for new hires as well as experienced staff.

Essential Functions

• Work closely with the Audit Team to determine ongoing training needs.
• Assist with auditing on trainees.
• Develop training materials for all training classes.
• Perform all new hire training according to schedule and topic list.
• Assist with interviewing claim department candidates.
• Process claims in the QicLink System when necessary.
• Review Clinical Logic appeals to suggest updates needed as well as to provide training to adjusters.
• Assist with the review of all Claim Department reports to find training opportunities.
• Attend continuing education classes as required, including but not limited to HIPAA training.

Position Qualifications

Communication – Communicates effectively both internally and externally, where applicable.  Includes both written and verbal communication.

Customer Focused – Works well with customers/clients both internal and external, promotes a positive image of the company and department

Dependability – Meets deadlines, works independently, accountable, maintains focus, punctual, and maintains good attendance record.

Initiative – Takes action independently, seeks new opportunities, and strives to see projects to completion.

Interpersonal Skills – Builds strong relationships, is flexible/adaptable, works well with others, and solicits feedback. 

Job Knowledge – Understands the facets of job, aware of duties and responsibilities, and keeps job knowledge current.

Organization Skills – Information organized and accessible maintains efficient work space, and manages time well.

Productivity – Manages workload, works efficiently, and meets goals and objectives. 

Self-Development – Looks for opportunities to increase knowledge, works to increase responsibility, strives to achieve personal goals and/or maintains licenses and other pertinent requirements. 

Sense of Urgency – Meets deadlines, establishes appropriate priority, and completes tasks assigned in timely manner.

Teamwork – Accountable to team, works to meet established deliverables, appreciates view of team members, and respectful.

Technical Skills – Maintains current understanding of technical process/equipment uses technology to increase performance/productivity; effectively uses online tools and resources. 

Education

High School Diploma, some College Preferred but not required.

Experience

Applicants must have prior Third Party Administrator (TPA) claims processing experience.

Training experience preferred but not required.

Applicants must have QicLink Systems experience.

Applicants must have a minimum of 5 years of medical claims analysis experience

Skills & Abilities

All applicants must have strong analytical skills and knowledge of computer systems and CPT and ICD-10 coding terminology.  Continuing education in all areas affecting group health and welfare plans is required.

Work Environment

This position is virtual with in-office training and continuing education hosted in Chicago and virtually.  At home work station must have high-speed internet connection.