Leads training programs for Claims and Configuration. Initiates, reviews and updates internal and external training documents. Facilitates training curricula, materials and programs. Performs quality checks and audits work of Claims and Configuration associates to ensure training content is mastered and work is preformed at an acceptable level.
- Conduct daily detailed quality reviews and root cause analysis of operations department processes ensuring accuracy across multiple systems. Root cause analysis will include reading of contracts, understanding provider contract loads, benefits configuration, processing guidelines in existence at the time of processing and what was subsequently used for auditing, understanding of the timing of fee schedule changes, and general process flow of the life of a claim
- Understand root cause of audit errors, documenting root cause and remediation
- Develop and implement remediation plans for errors / issues identified through root cause analysis or via other avenues
- Ensure understanding of operational processes to identify process improvement opportunities.
- Document attendance, participation and outcomes from training programs
- Serve as a direct interface for claims teams and vendor leaders to obtain clarification on technical processing issues; will require interfacing within WellCare departments to obtain correct answers and effective communication to the processing teams
- Manage group dynamics through the use of "learner focused" environment and blended adult learning methods facilitating company training programs.
- Track and analyze training programs by examining training participant' job performance.
- Analyzes course evaluations in order to judge effectiveness of training sessions and to implement suggestion for improvements.
- Produce professional color presentations and training materials using MS Word, PowerPoint and other desktop publishing software.
- Produce routine performance-focused reports, including results trending, analysis summaries, conclusions and recommendations
- Review all program documents assigned for completeness and continuously ensure they meet the rigorous standards that are set forth by Training Manager.
- Coordinates all activities relative to the introduction and publication of new documents (i.e. SATs, workflows, decision trees, job aides, etc.) and the revision maintenance of existing documents. Ensures obsolete documents are archived appropriately.
- Perform periodic reviews of the documents and ensure change control practices are compliant. Maintain records as evidence of adherence to requirements for all Lines of Business and of effective operation of the system.
- Revise existing training materials and programs based on audit results, questionnaires, changing procedures and feedback from internal/ external customers, subject matter experts, program sponsors and trainers.
- Assess, design and develop instructional materials including training manuals, teaching aids, self-paced study and performance evaluation tools.
- Conduct research for needs assessments and provide written complete detailed recommendations to Training Manager.
- Coordinate and organize enrollment of students, assemble necessary program materials, setup of classroom, ordering of supplies, catering and other functions related to Operations training.
- Track and maintain quality results for appropriate distribution
- Become a subject matter expert on Claims and Configuration processes
- Assist with special projects and other duties as assigned
- High School Diploma required; College degree preferred or directly related or equivalent work experience.
- Minimum 5 years experience in a healthcare organization; preferably in Claims or Configuration.
- Previous training and/or supervisory experience preferred.
- Direct WellCare experience in claims or configuration shall be weighted appropriately in assessment of this requirement
Special Skills (e.g. 2nd language):
- Ability to routinely multitask
- Ability to work in a fast paced environment with changing priorities
- Ability to remain calm under pressure
- Ability to sit for extended periods of time
- Ability to perform detailed review, research, and analysis to ensure Operational accuracy across multitude of systems, including Peradigm claims and config, AdminiStep, Christmas Tree, and others as may be necessary
- Knowledge of MS Outlook sufficient to communicate with internal and external contacts
- Knowledge of MS Word sufficient to create complex written instruction guides that serve as the basis for claims processing and as the official source of claims processing information
- Knowledge of MS Excel sufficient to create spreadsheets containing formatting, totals and averages, enter data into spreadsheets. Also will need to demonstrate ability to use or quickly learn the use of Pivot tables and Charting
- Knowledge of MS PowerPoint sufficient to create effective presentations, communicating information in graphical and written format
- Domestic and international travel may be necessary on an infrequent basis