Claims Process Documentation, Training Specialist

🕒 vor 13 Tagen

🗽 New York – Remote

🗽 New York – Remote

💵 $75.000 - $80.000 / Jahr

⏰ Vollzeit

🟡 Mittelstufe

🟠 Senior

📚 Personalentwickler

🦅 H1B-Visum-Sponsor

Dieses Unternehmen hat in der Vergangenheit H1B-Visa gesponsert.

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Centivo

WebsiteLinkedInAlle Stellen

201 - 500 Mitarbeiter

Gegründet 2017

🏥 Gesundheitswesen

🛡️ Versicherung

⚕️ Krankenversicherung

Healthcare • Insurance • Healthcare Insurance

Centivo ist ein innovativer Anbieter von Krankenversicherungsplänen für selbstfinanzierte Unternehmen, der sich darauf konzentriert, hochwertige Gesundheitsversorgung zu erschwinglichen Kosten anzubieten. Das Unternehmen ist von der Kraft der hausärztlichen Versorgung überzeugt, um Gesundheitsresultate zu verbessern und Kosten zu senken. Centivo bietet Pläne mit kostenfreier primärer Gesundheitsversorgung, ohne Selbstbeteiligung und niedrigen, vorhersehbaren Zuzahlungen an, wodurch die Mitglieder ermutigt werden, ihre Gesundheitsleistungen ohne finanzielle Hürden zu nutzen. Die Pläne sind darauf ausgelegt, strengen Preis- und Qualitätsstandards zu entsprechen, fördern eine starke Beziehung zu Hausärzten und integrieren virtuelle Versorgungsoptionen. Der Ansatz von Centivo zielt darauf ab, die gesamten medizinischen Ausgaben zu senken und gleichzeitig das Gesundheitserlebnis für Arbeitgeber und Mitarbeiter zu verbessern.

Beschreibung

• Develop, document, and maintain end-to-end claims business processes and workflows, ensuring clarity, accuracy, and usability for claims team members. • Test claims workflows in Javelina and HRP to confirm processes function as designed and align with system configuration. • Document all new claims processes step-by-step in Confluence for use by claims team members when adjudicating claims. • Ensure documentation follows instructional design principles, is written in execution order, and includes screenshots as appropriate. • Own and manage all existing claims process documentation in Confluence, (in addition to including creating new documentation) including editing existing content, archiving outdated materials, deleting obsolete content, etc. • Build and maintain an intuitive documentation structure and search taxonomy to ensure ease of use and accessibility. • Create training and reference materials for the Claims organization, including Processors, Auditors, Recovery Analysts (including NSA and Subrogation), Appeals. • Design and deliver specialty claims training as needed to support new processes, system changes, or operational initiatives. • As needed, support training and onboarding of Claims new hires. • Partner with POP, Core Platform, and PMO teams to ensure claims process documentation aligns with new hire training, system configuration, and operational standards. • Partner with POP as a subject matter expert to ensure claims process and adjudication content is accurate, providing quality review of new hire and enhanced training materials (including COB, adjustments, and corrected claims) and advising on the appropriate sequencing of content within new hire training. • As needed, support claims operations by processing claims to assist with workload coverage and inventory management.

🎯 Anforderungen

• 3 years’ experience working in Claims healthcare within a payer and/or TPA environment, with a strong understanding of medical claims processing and adjudication. • 3 years demonstrated experience writing clear, detailed process documentation and/or developing training materials for operational teams. • Experience testing workflows or processes within claims systems to ensure accuracy, functionality, and usability. • 3 years' experience conducting instructor-led and/or virtual training sessions, including onboarding and specialty training, for claims or healthcare operations teams. • Experience working within claims platforms such as Javelina and HRP, including navigating, testing, or supporting claims workflows. • Experience using HRP for claims processing is highly preferred. • Excellent written and verbal communication skills, with the ability to serve as a subject matter expert and partner effectively across cross-functional teams. • Highly organized with strong attention to detail, including experience managing and maintaining documentation repositories and training resources. • Strong understanding of instructional design principles and the ability to translate complex payer/TPA claims processes into easy-to-follow documentation and learning tools. • Strong interpersonal skills, establishing rapport and working well with others.

🏖️ Vorteile

• Offers Equity • Offers Bonus