Job Summary:
The Customer Solutions Center Appeals and Grievances (A&G) Training Specialist II is primarily responsible for the overall training strategy across the department. This position designs and conducts training programs using established regulatory and departmental guidelines.
This position is responsible for providing ongoing training on the core processing system, A&G processing procedures, training regulatory changes which will affect established procedures, working with the quality team on quality and performance guidelines, creating and maintaining departmental policy and procedures. Additional responsibilities include evaluating initial training and ongoing learning opportunities to achieve consistency, efficiency, and productivity among the staff.
Duties:
Applies knowledge and skills to build competencies for the design of training programs that will boost employee's workplace performance in alliance with Enterprise and departmental goals.
Responsible for performing training needs assessments with the department management and will leads the design and delivery of curriculum and learning materials to ensure the success of new and current staff.
Conducts training for Customer Solution Center A&G team in customer service, product operations, and other work processes. Conducts training sessions covering specified areas such as on-the-job training, use of computers and software, interpersonal skills, quality & process issues, and product knowledge.
Maintain documentation, including database/system updates, training agendas, sign-in sheets, etc. to demonstrate trainee compliance with department requirements.
Work with key stakeholders to monitor error trends, productivity, and quality standards for the program.
Identifies gaps in knowledge, skills and abilities, assess and recommend training/education measures to resolve issues and enhance staff performance.
Propose program modifications to enhance performance and positively influence member satisfaction survey results.
Conduct assessments after training to measure, record, and report feedback on training material and sessions.
Serve as coach staff to handle problems and concerns as they arise.
Review and recommends updates on policy and procedure critical to claims process.
Perform other duties as assigned.
Required Skills, Experience & Qualifications:
Bachelor's Degree in Business Administration or Healthcare Related Field.
In lieu of degree, equivalent education and/or experience may be considered.
A minimum of 3-5 years of Managed Care, Medicaid, Medicare experience required.
A minimum of 3-5 experience in design and delivery (facilitating and coordinating) of training programs.
Must have 3 years experience in Healthcare Industry.
Managed Care experience.
Appeals & Grievances experience-preferably as Lead.
3 years experience designing and conducting trainings as a true Trainer.
Strong understanding of learning principles and ability to demonstrate in classroom (or virtual classroom) situations.
Knowledge of CA regulatory guidelines, Medi-Cal guidelines, Medicare guidelines, NCQA requirements.
Skilled in group facilitation and managing effective discussion and dialogue to enhance the learning experience.
Strong organizational & analytical skills.
Ability to conduct effective and engaging presentations in a variety of delivery settings.
Ability to interpret technical data, processes, operating and maintenance instructions and procedure manuals.
Must be a strong team player willing to work toward achieving team goals.
Must be flexible to meet the changing training needs.
Professional demeanor.
Commitment to Team Culture.
Excellent written and verbal communications skills.
Proficient using Word, Excel, Power Point and Access.