Claims Trainer

This is a fully remote position, open to applicants in United States.

📋 Description

• Create and facilitate instructor-led, virtual, and self-paced training for examiners.

• Address adjudication logic, benefit interpretation, coordination of benefits, and system navigation.

• Oversee session scheduling, monitor progress, and manage certification processes.

• Collaborate with Quality Audit to transform error trends into focused refresher training.

• Educate team leads and subject-matter experts to effectively deliver training.

• Monitor quality, productivity, and turnaround time in relation to training outcomes.

• Develop and implement training for new business lines, system rollouts, and platform migrations.

• Author and update claims procedures, workflow guides, and job aids.

• Interpret regulatory, policy, and configuration updates into immediate guidance.

• Maintain a version-controlled library of procedures.

• Ensure procedures comply with state, federal, ERISA, and CMS standards.

• Create process flow diagrams and decision trees for intricate claims.

• Validate training and procedural content against live system benefit configurations.

• Coordinate go-live readiness with IT and platform vendors.

• Provide organized documentation for regulatory examinations and internal reviews.

• Identify gaps in processes, training, and documentation to present to Claims Operations leadership.

⛳️ Requirements

• Bachelor's degree or equivalent experience in health insurance claims.

• Over 5 years of experience in processing, auditing, or configuring health insurance claims across medical, dental, and vision.

• At least 3 years of experience in developing or delivering training curriculum or technical/procedural documentation, preferably within a health plan or managed care setting.

• Familiarity with Medicare Advantage, Medicaid, or ASO/self-funded claims is advantageous.

• Background in claims examiner certification is a plus.

• Proficient knowledge of core claims platforms (Javelina, ElDorado, QicLink, Facets, or similar).

• Solid understanding of standard claims coding (CPT, HCPCS, ICD-10, revenue codes).

• Knowledge of CMS guidelines, state prompt-pay laws, HIPAA, and ERISA regulations.

• Experience in instructional design and familiarity with LMS platforms (Cornerstone, Workday Learning) is preferred.

• Familiarity with process-mapping and documentation tools (Visio, Lucidchart, SharePoint, Confluence) is preferred.

• A background in Six Sigma or quality improvement is a plus.

🏝️ Benefits

• Competitive base salary.

• Benefits begin on the first day of employment.

• Comprehensive medical and dental coverage.

• Unlimited Paid Time Off (PTO).

• Support for mental health.

• Retirement planning assistance.

• Financial protection options.

• Opportunities for professional development.

• Clear pathways for career progression.

• Learning budgets available.

• Wellness programs offered.

• Additional employee perks.

• A mission-driven culture where diverse perspectives create genuine impact.