Claims Process Documentation, Training Specialist

🕒 il y a 13 jours

🗽 New York – Distant

🗽 New York – Remote

💵 $75 000 - $80 000 / an

⏰ Temps Plein

🟡 Intermédiaire

🟠 Senior

📚 Formation et Développement

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Centivo

Site WebLinkedInTous les Emplois

201 - 500 employés

Fondée en 2017

🏥 Santé

🛡️ Assurance

⚕️ Assurance santé

Healthcare • Insurance • Healthcare Insurance

Centivo est un fournisseur innovant de régimes de santé pour les employeurs autofinancés, axé sur la prestation de soins de santé de haute qualité à un coût abordable. L'entreprise croit au pouvoir des soins primaires pour améliorer les résultats de santé et réduire les coûts. Centivo propose des plans avec des soins primaires gratuits, sans franchises, et avec des co-paiements faibles et prévisibles, encourageant ainsi les membres à utiliser leurs avantages santé sans contrainte financière. Les plans sont conçus pour répondre à des normes de prix et de qualité strictes, favorisant une relation solide avec les prestataires de soins primaires et intégrant des options de soins virtuels. L'approche de Centivo vise à réduire les dépenses médicales globales tout en améliorant l'expérience des soins pour les employeurs et les employés.

Description

• 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in Confluence, (in addition to including creating new documentation) including editing existing content, archiving outdated materials, deleting obsolete content, etc.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.

🎯 Exigences

• 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.

🏖️ Avantages

• Offers Equity • Offers Bonus