Claims Training Specialist

Mission

Our mission is to enhance well-being by connecting individuals with vital health resources through a compassionate workforce that embodies the spirit of neighbors helping neighbors.

Values

HealthOne is guided by a cultural framework that embodies our values and drives our decisions.

As a company our PURPOSE is to care for people by connecting them to resources that help protect them in health related situations. We fulfill our purpose by filtering our decisions through a PRIORITIES lens of asking, "Is what we are about to do ethical, empathetic, economical, and efficient?". By caring for PEOPLE, we are welcoming, authentic, truthful, consistent, and humble. We are continuously looking for ways to improve our PROCESS and how we get things done.

HealthOne seeks individuals with integrity and heart to embody our values. Whether you're starting your career or looking to develop additional skills to reach your full potential, HealthOne provides the means to help you achieve your goals.

Job Purpose

The Claims Training Specialist I assists in the design and training curriculum, materials, and programs for the Claims Department. Works closely within the Claims Department and the Training Department to establish and maintain training materials for Claims, Appeals, Audits, and Configuration staff. Participates in training existing staff as well as new hires.

Essential Job Duties

• Delivers established training for new hires and existing Claims, Appeals, Audits, and Configuration staff using approved curricula, procedures, job aids, presentations, and system demonstrations.
• Assists the Claims Training Specialist II with developing and updating training based on departmental needs, identified knowledge gaps, audit findings, process changes, system updates, and employee questions.
• Assists with coordinating training schedules for new hires, existing staff, refresher training, and follow-up training.
• Coordinates with Department Supervisors and Subject Matter Experts to obtain information, confirm established processes, and support training and documentation schedules.
• Delivers follow-up and remedial training using plans and materials developed in collaboration with the Claims Training Specialist II, Department Supervisors, and Subject Matter Experts.
• Documents each training session, including the topic, objectives, materials covered, attendees, employee questions, practice activities, identified knowledge gaps, and required follow-up.
• Facilitates hands-on exercises, real-life claim scenarios, system demonstrations, knowledge checks, and practical activities to reinforce established learning objectives.
• Creates, updates, and maintains training materials, including Desktop Procedures, job aids, presentations, reference guides, exercises, and knowledge assessments, with appropriate review and approval.
• Performs scheduled reviews of training materials and published documentation to identify outdated information, broken links, missing instructions, or inconsistencies.
• Performs validation testing of documented procedures by following each step, recording the results, and confirming that Claims staff can successfully complete the documented process.
• Identifies discrepancies, unclear instructions, missing steps, and documentation gaps and escalates findings to the Claims Training Specialist II, Department Supervisor, or appropriate Subject Matter Expert.
• Implements approved documentation changes and confirms that current versions are published in the appropriate departmental location.
• Collects training evaluations, knowledge-check results, employee questions, and other feedback and provides the results to the Claims Training Specialist II and Department Supervisors.
• Monitors participant comprehension during training and communicates areas requiring additional instruction, practice, or follow-up.
• Provides individual and group training support within the scope of approved processes and escalates complex claims, configuration, or policy questions to the appropriate resource.
• Collaborates with the Claims Training Specialist II on training development, documentation reviews, process validation, training needs assessments, and departmental training initiatives.
• Participates in departmental meetings, training meetings, and process-review sessions as assigned.
• Maintains organized training records, attendance documentation, training materials, validation results, and follow-up records in accordance with departmental requirements.
• Creates a positive, professional, and inclusive learning environment and uses approved training methods to support different learning needs.
• Maintains regular and predictable attendance.
• Consistently complies with HIPAA requirements, company policies, professional conduct standards, and ethical practices.
• Supports and promotes company culture throughout the organization.
• Performs other duties as assigned.

Qualifications

• Requires a high school diploma or its equivalent
• Knowledge of healthcare billing and claims
• Confidentiality and time management skills
• Ability to learn quickly and be self-motivated
• Strong aptitude for Microsoft Office products (i.e., PowerPoint, Excel, Word) is preferred
• Health insurance experience

Physical Requirements

• Prolonged periods of sitting at a desk and working on a computer.
• Moderate to significant amount of stress in meeting deadlines and dealing with day-to-day responsibilities.
• Must be able to drive a vehicle and daytime/overnight travel as required.

Benefits

• 401K (4% Match, Immediate Vesting)
• Accident insurance
• Competitive salary
• Critical Illness Insurance
• Dental Insurance
• Employee Assistance Program
• Flexible Spending Account
• Health & Wellness Program
• Health Savings Account
• Life & AD&D Insurance
• Long Term Disability
• Medical Insurance
• Paid Time Off
• Pet Insurance
• Short Term Disability
• Vision Insurance
• PRE-EMPLOYMENT SCREENING
• Drug Screen and Background Check Required