Especialista de Adiestramiento de Reclamaciones
Regular
Exempt
GENERAL DESCRIPTION:
Responsible for developing and leading Claims trainings programs for the career jobs ensuring compliance with MCS's standards, policies, and procedures and regulatory agencies. Conducts focused training needs assessments within specified targeted adult populations; designs develops, delivers, and evaluates a range of responsive educational curricula and training programs within defined fields of expertise.
ESSENTIAL FUNCTIONS:
Keeps the Claims Policies and Procedures Manual for all business lines up to date with changes in procedures and policies.
Provides technical assistance concerning the claim adjudication process to other departments when necessary.
Performs testing of changes to payment rules, new Medicare policies, changes to fee schedule, prices, and contracting of providers, among others.
Ensure training programs are executed properly and at an accurate time, while also providing updates or reports to the upper management on the progress of programs.
Monitors various training activities and evaluates the effectiveness of programs, designs and develops training manuals and course materials which may include handouts and visual materials.
Identifies requirements to meet training needs and several other facilitating duties.
Formulates training outlines and determines instructional methods, utilizing knowledge of specified training needs and effectiveness of such methods as individual training, group instruction, lectures, demonstrations, conferences, meetings, and workshops.
Evaluate the effectiveness of training and development programs and utilize relevant evaluation data to revise or recommend changes in instructional objectives and methods.
Discusses with management the individual results of each analyst of the analyses carried out to identify areas of improvement, such as but not limited to assembly corrections in the systems used, modification and standardization of processes, retraining of personnel, and application of payment rules.
Coordinates or performs administrative functions necessary to deliver and document training programs.
Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.
MINIMUM QUALIFICATIONS:
Education & Experience:
Bachelor's degree, preferable in Business Administrations, Education or related areas. At least two (2) years of experience in the industry. Analytical and statistical knowledge. Knowledge of the processing of claims. Familiarity with quality parameters in the industry.
"Proven experience may be replaced by previously established requirements"
Certifications / Licenses:
N/A.
Other:
Knowledge of process monitoring and evaluation (desirable). Knowledge of Excel, Word, Access, and/or PowerPoint.
Languages:
Spanish -
Advanced (grammatical, comprehension, and conversational)
English -
Intermediate (grammatical, comprehension, and conversational)
"Somos un patrono con igualdad de oportunidad en el empleo y tomamos Acción Afirmativa para reclutar a Mujeres, Minorías, Veteranos Protegidos y Personas con Impedimento
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