Auditor, Claims Training and Technical

ACCOUNTABILITIES:

Plans, organizes and delivers claims training programs using diverse training methodologies and approaches for claims and administrative staff. Training programs include:

Systems training: Digital Equipment Corporation (DEC), Adjustment Tracking System, Claims Overpayment Refund/Recovery System, HealthPartners Customer Service System (HCSS).

Soft skills training: customer service training and business writing training.

Others: new projects, specialization, enrichment training and updates to existing programs for both automated and manual systems.

Ensures new and promoting employees technical competence to heighten production and quality standards.

Prepares, conducts and analyzes user audits to improve and maximize system use.

Identifies system and/or benefit errors and recommends process improvement changes.

Shares audit results with all new and promoting employees on a 1:1 basis. Keeps supervisor informed.

Enters all audit results into the Claims audit tracking system for individual employee tracking, reporting and future trend analysis.

Initiates the certification process for all levels of claim processing for new and promoting employees.

Plans, organizes and delivers claims training programs using diverse training methodologies and approaches for claims staff and administrators.

Supports departmental and divisional teams through participation in appropriate meetings and projects.

Serves as an internal consultant to managers and claims staff regarding procedural and system related processes, automated and manual. Consulting includes as hoc requests by claims Director, Managers or Supervisor.

Maintains a current knowledge base and utilizes new training delivery techniques and practices and updates current documentation for on-line claims processing.

Promotes teamwork through the practice of Covey and CQI philosophy by leading or participating in-group efforts to analyze departmental workflow and processing methods.

Performs benefit interpretation to define and facilitate development of policies and procedures resulting from implementation or revision of claims processing procedures. Provides on-line documentation to staff.

Develops appropriate measurement techniques to measure progress and/or deficiencies and provides trend analysis reporting of performance.

Makes suggestions for system improvements to enhance automation and accuracy.

Performs additional duties, attends meetings and assumes projects as assigned by Supervisor, Manager or Director.

REQUIRED QUALIFICATIONS:

BA/BS in training and organizational development, industrial relations, communications and two years claims experience in the administration of insurance benefits or Associate degree and four years of HP claims experience and/or the equivalent relevant experience.

One year experience in the design and delivery of training programs which includes some technical training and/or the equivalent relevant experience.

Experience using desktop publishing software such as Microsoft Word, Excel and PowerPoint.

Experience working with HTML.

Detailed knowledge of adult learning theories and methods of instruction.

Detailed knowledge and understanding of the insurance industry including, claims processing and customer service expectations.

Advanced analytical and problem solving skills.

Effective presentation, planning and oral and written communication skills

Ability to interpret and explain provider and member/employer contracts and has a strong customer service orientation.

Ability to communicate at all levels of the organization and with external customers.

Ability to handle and manage a high degree of change.

Ability to work independently and as a team player.

Ability to evaluate employee progress to ensure that the business needs of the department are being met.

Familiarity with training equipment and materials.

PREFERRED QUALIFICATIONS:

Master’s degree in training and organizational development, industrial relations, communications, business administration or other relevant field.

Three to five years full-time training experience in a hospital, ambulatory care, or insurance environment, including some technical training background.

We’re a nonprofit, integrated health care organization, providing health insurance in six states and high-quality care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin. We bring together research and education through HealthPartners Institute, training medical professionals across the region and conducting innovative research that improve lives around the world.

At HealthPartners, everyone is welcome, included and valued. We’re working together to increase diversity and inclusion in our workplace, advance health equity in care and coverage, and partner with the community as advocates for change.

Benefits Designed to Support Your Total Health
As a HealthPartners colleague, we’re committed to nurturing your diverse talents, valuing your dedication, and supporting your work-life balance. We offer a comprehensive range of benefits to support every aspect of your life, including health, time off, retirement planning, and continuous learning opportunities. Our goal is to help you thrive physically, mentally, emotionally, and financially, so you can continue delivering exceptional care.

Join us in our mission to improve the health and well-being of our patients, members, and communities.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant because of race, color, sex, age, national origin, religion, sexual orientation, gender identify, status as a veteran and basis of disability or any other federal, state or local protected class.