Claims Trainer

Job not on LinkedIn

🔥 4 hours ago

🇺🇸 United States – Remote

💵 $65k - $78k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Personify Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2023

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Personify Health is the first personalized health platform company, designed to empower individuals and organizations to achieve better health outcomes through tailored solutions and services. They offer a comprehensive range of solutions including wellbeing navigation, care management, and health plan administration, catering to employers, health systems, health plans, and brokers. Their goal is to simplify healthcare experiences and enhance engagement, ultimately helping businesses optimize their investment in employee health and wellbeing.

📋 Description

• Design and deliver instructor-led, virtual, and self-paced examiner training • Cover adjudication logic, benefit interpretation, coordination of benefits, and system navigation • Manage session scheduling, progress tracking, and certification • Partner with Quality Audit to convert error trends into targeted refresher training • Train team leads and subject-matter experts to deliver training • Track quality, productivity, and turnaround time against training outcomes • Build and launch training for new lines of business, system rollouts, and platform migrations • Author and maintain claims procedures, workflow guides, and job aids • Translate regulatory, policy, and configuration updates into same-day guidance • Maintain a version-controlled procedure library • Validate procedures against state, federal, ERISA, and CMS requirements • Build process flow diagrams and decision trees for complex claims • Validate training and procedure content against live system benefit configuration • Coordinate go-live readiness with IT and platform vendors • Provide organized documentation for regulatory exams and internal reviews • Surface process, training, and documentation gaps to Claims Operations leadership

🎯 Requirements

• Bachelor's degree or equivalent experience in health insurance claims • 5+ years processing, auditing, or configuring health insurance claims across medical, dental, and vision • 3+ years building or delivering training curriculum or technical/procedural documentation, ideally at a health plan or managed care organization • Experience with Medicare Advantage, Medicaid, or ASO/self-funded claims • Claims examiner certification background a plus • Working knowledge of core claims platforms (Javelina, ElDorado, QicLink, Facets, or similar) • Working knowledge of standard claims coding (CPT, HCPCS, ICD-10, revenue codes) • Working knowledge of CMS guidelines, state prompt-pay laws, HIPAA, and ERISA • Instructional design background and familiarity with LMS platforms (Cornerstone, Workday Learning) preferred • Experience with process-mapping and documentation tools (Visio, Lucidchart, SharePoint, Confluence) preferred • Six Sigma or quality improvement background a plus

🏖️ Benefits

• Competitive base salary • Benefits effective day one • Comprehensive medical and dental coverage • Unlimited PTO • Mental health support • Retirement planning • Financial protection • Professional development • Clear career progression • Learning budgets • Wellness programs • Other employee perks • Mission-driven culture where diverse perspectives drive real impact