Claims Trainer

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🤠 Texas – Remote

🤠 Texas – Remote

💵 $47k - $67.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

📦 Logistics

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Consulting • Logistics • Healthcare Insurance

Gainwell Technologies is the nation’s leading provider of digital and cloud-enabled solutions across the human services and public health ecosystem. With a mission-driven approach, Gainwell serves clients in all 50 U. S. states, focusing on improving health outcomes and delivering intuitive, human-centered experiences. Their comprehensive suite of solutions includes Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions, all designed to advance the future of healthcare and enhance community well-being.

📋 Description

• Develop, maintain, and deliver training programs covering Coordination of Benefits, Medicaid Reclamation, commercial medical claims processing, appeals, auditing procedures, and reimbursement methodologies • Facilitate virtual instructor-led training, onboarding programs, refresher courses, workshops, and one-on-one coaching for new and existing employees • Create and maintain training materials, job aids, process documentation, presentations, assessments, knowledge checks, and standard operating procedures • Translate complex claims policies, procedures, and regulatory requirements into practical learning solutions • Evaluate learner performance through assessments, observations, and practical exercises, providing coaching and feedback • Partner with operations leaders, quality teams, auditors, and subject matter experts to identify training needs and keep content aligned with current processes • Analyze quality reviews, audit findings, and operational trends to identify knowledge gaps and develop targeted training solutions • Research policy updates, reimbursement changes, system enhancements, and operational requirements to keep training content current and accurate • Update training programs based on Medicaid regulations, client requirements, reimbursement guidelines, and internal processes • Serve as a technical resource regarding COB and Medicaid claims processing procedures • Measure training effectiveness and recommend improvements to curriculum, delivery methods, and learning resources • Perform auxiliary functions supporting departmental and operational needs

🎯 Requirements

• Significant professional experience as a medical claims examiner, claims auditor, claims processor, or healthcare claims subject matter expert • Strong knowledge of Medicaid claims processing, Coordination of Benefits, reimbursement methodologies, claims recovery, Medicaid reclamation, and related operational procedures • 3+ years of documented experience in Medicaid reclamation, including overpayment identification, recovery efforts, reimbursement reconciliation, and Medicaid regulatory compliance • Previous supervisory, team lead, coaching, training, or employee development experience • Ability to develop technical training materials, process documentation, job aids, and standard operating procedures • Excellent presentation, facilitation, communication, and interpersonal skills • Ability to train, mentor, and coach employees in a virtual environment • Ability to comply with client, company, privacy, security, and healthcare program requirements

🏖️ Benefits

• Work flexibility • Learning and career development • Flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies • Virtual work arrangement