Training Administrator (Claims)

Training Administrator (Claims)

CalOptima

CalOptima Health is seeking a highly motivated an experienced Training Administrator to join our team. The Training Administrator will be responsible for designing, implementing, and conducting training programs for customer service representatives, business analysts, auditors, and recovery analysts within the Claims department. The incumbent will ensure that staff are equipped with the necessary skills and knowledge to handle claims-related phone calls and/or assignments efficiently and effectively. This role will involve creating training materials, delivering both classroom and on-the-job training, and assessing the effectiveness of training programs.

Position Information:

• Department: Claims Administration
• Salary Grade: 308 - $64,165 - $102,664 ($30.85 - $49.3577)
• Work Arrangement: Partial Telework
  
  **This position is eligible for telework in California.**

Duties & Responsibilities:

• 85% - Training Administration
  • Designs, develops, and delivers training via traditional and virtual classroom methods, including one-on-one sessions, job aids, participant/instructor guides, and/or any combination thereof.
  • Develops, administers, and analyzes questionnaires, surveys, practice exercises, and pre/post-assessments to determine the effectiveness of the training programs.
  • Serves as the subject matter expert and resource for CMS and/or DHCS claims processing regulatory guidelines.
  • Continuously improve training methods and materials based on feedback and performance analysis
  • Performs a thorough review of Centers for Medicare & Medicaid Services (CMS) and Department Health Care Services (DHCS) processing guidelines. Ensures policies and desktops align with applicable statutory, regulatory, contractual, and other CalOptima Health obligations.
  • Supports the overall process for policy and procedure development.
  • Facilitates development, review, and approval of policies with management.
  • Develops and maintains training program to manage updates to department policies to ensure organization is using most up to date processes.
  • Facilitates and oversees the training program for policy and procedure updates.
  • Maintains and implements updated regulatory requirements per regulatory guidance.
  • Identifies needs assessments and training opportunities which includes establishing training and development plans based on audit results, health plan audit findings, and management input.
  • Performs root cause analysis on audit errors and determines training needs if applicable.
  • Updates and maintains trainee performance scores. Works closely with management on trainee performance metrics and roster updates.
  • Develops training knowledge base tools or reporting and trending for management as needed.
  • Researches and distributes weekly processing alerts and processing tips based on quality trend reports.
    
    
• 10% - Administrative Support
  • Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
  • Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
  • Presents policy changes to the Policy Review Committee (PRC) and other applicable entities such as Compliance or Project Management Organization.
  • Develops and updates training materials to reflect changes in policies and procedures and desk level procedures to provide clarity as applicable.
  • Collaborates with management and team to monitor and create action plans based on training results.
  • Partners with the Claims Audit team to conduct audits of new hires to ensure understanding and application of guidelines until acceptable accuracy is attained and the new hire is released.
    
    
• 5% - Completes other projects and duties as assigned.

Minimum Qualifications:

• Bachelor's degree in healthcare administration or a related field required.
  
• 3 years of experience in instructor led training, content/training curriculum creation, and delivery role required.
  
• 2 years of experience in a healthcare or managed care setting, with relevant experience in policies, procedures and development required.
  
• An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
  

Preferred Qualifications:

• Experience in the development and delivery of training for large initiatives.
  
• Experience in a lead role within a customer service department and any other variety of roles within a claims or support functions team.
  

Required Licensure / Certifications:

• N/A

Knowledge & Abilities:

• Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule; available to participate in evening and weekend events.
• Organize, be analytical, problem-solve and possess project management skills.
• Work in a fast-paced environment and in an efficient manner.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Motivate and lead multi-program teams and external committees/coalitions.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Physical Requirements (With or Without Accommodations):

• Ability to visually read information from computer screens, forms and other printed materials and information.
• Ability to speak (enunciate) clearly in conversation and general communication.
• Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
• Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
• Lifting and moving objects, patients and/or equipment 10 to 25 pounds

Work Environment:

If located at the 500, 505 Building or a remote work location:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• There are no harmful environmental conditions present for this job.
• The noise level in this work environment is usually moderate.

If located at PACE:

• Work is typically indoors in a clinical setting serving the frail and elderly.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.

If located in the Community:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• Employee will occasionally work outdoors in varied temperatures.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.

About CalOptima Health:
CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay!

About our Benefits & Wellness options:
At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2024 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package.

IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS

Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is August 12, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date.

The selection process may include, but is not limited to, a skills assessment, phone screen and interview.

The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet.

Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application.

CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together.

CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.

If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.


To apply, please visit: https://jobs.caloptima.org/jobs/training-administrator-claims-505-city-parkway-west-california-united-states







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