Claims Lead Trainer (Full-time Hybrid, Morrisville, North Carolina Based) (Administrative)

The Claims Lead Trainer provides training/development, consultation, and direction to Claims Research Analysts and collaborates with Claims leadership and other departments to improve claims processes and Claims system changes.   The Claims Lead Trainer also facilitates peer reviews and independent claims audits to identify areas for improvement and correction.  The position provides guidance and training/technical assistance to network providers in an effort to strengthen the performance of Alliance Health's provider partners. This position creates reporting tools to aid in identification of areas needing attention and to communicate performance.  

This position is a hybrid position, working in the office up to 5 days per week, depending on the needs of the business and presence of Claims Research Analyst staff on site.

Responsibilities & Duties

Provide Guidance and Consultation to lower-level Claims staff

• Assist the Claims Research Analysts in reviewing claim errors
• Provide daily consultation to Claims Research Analysts to resolve processing issues
• Facilitate monthly peer reviews
• Ensure staff is taking the appropriate steps even when it may require escalation for resolution

Provide Training and Development to Claims staff

• Onboard and train new claims staff

• Provide ongoing in-person and virtual learning opportunities to include 1:1 training, shadowing, and provision of routine feedback

• Provide claims processing training for new and existing staff

Provide Training/Technical Assistance/Resolutions to Providers 

• Facilitate in-person and virtual claims processing training for providers
• Provide technical assistance on claims processing issues to providers
• Research provider concerns or complaints and resolve. Escalate complaints to grievance team when appropriate

Analyze Data and Make Recommendations

• Review and analyze daily, weekly and monthly reports to help track processes and recommend procedure and process changes to increase productivity 
• Review claims production and quality levels for performance and monitor Provider/Member feedback.  Communicate areas of staff performance concerns to supervisors
• Monitor and record performance measures and compile performance reports 

Improve Quality of Claims Processing Procedures and Performance

• Develop and implement approved new and updated procedures and desk references to improve quality and performance
• Stay abreast of related regulatory, compliance and departmental updates to meet departmental metric requirements
• Collaborate with Contracts, Credentialing, Enrollment, Provider Network, Utilization Management, and Provider Support teams to assist providers with successful claims submissions
• Maintain a working knowledge of Provider Network functions to appropriately advise/guide providers with claims-related issues
• Collaborate with Utilization Management to resolve and manage system changes to allow for successful claims adjudication

Support Expansion and New Business

• Research requirements in current and future contracts, including coverage of additional catchment areas, new covered services, and processing and handling of physical health claims and communicate recommendations on process improvements needed 
• Identify new skills needed, learn the new skills, and prepare presentations and training for other Claims staff

Minimum Requirements

Education & Experience

Bachelor's Degree or equivalent and two (2) or more years of related experience in education/training OR processing behavioral and physical health claims with analysis of claims processing data

Preferred experience

Experience leading a team and conducting trainings and presentations

Knowledge, Skills, & Abilities

• Claims Processing- Behavioral, Physical
• Training/Presentation
• Microsoft Office Package
• Communication- Verbal
• Organization
• Complex Problem Solving
• Time Management; Prioritization
• Customer Service; Interpersonal Relationships
• Written Communication; Reporting
• Data Processing (typing, modifying, etc)

Salary Range

$25.75 - $32.83/Hourly

Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity. 

An excellent fringe benefit package accompanies the salary, which includes:   

• Medical, Dental, Vision, Life, Long Term Disability
• Generous retirement savings plan
• Flexible work schedules including hybrid/remote options
• Paid time off including vacation, sick leave, holiday, management leave
• Dress flexibility

Education

Required

• Bachelors or better in General Studies

Skills

Required

• Claims Processing
• Communication
• Microsoft Office
• Problem Solving
• Time Management

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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