Health Care Trainer

Job Title:

Reports To (Title):

Job Location:

Job Summary:

We are looking for a training specialist to help employees and trainers cultivate their skills and knowledge. The expectation of the role is not only to transfer knowledge and skill but also to motivate and set examples to achieve high levels of excellence.

Job Responsibilities:

• Training of new hires on fundamental skills essential for entry level performance – concepts of US Healthcare and client specific training requirements
• Support business with need-based OJT Support – Coaching and Refresher Training
• Manage performance, development and adherence to organizational policies for trainees (levels 1-3)
• Training need assessment – parameter-based assessment for root cause analysis and action planning
• Content Development and implementation and evaluation of training projects
• Conduct employee engagement activities to maximize conversion
• Providing stakeholders with insights into business development and expansion
• Providing insights into automation capabilities
• Maintaining governance mechanisms that adhere to PCIDSS and ISO Standards

Competency Requirement

• Communication Skills (Oral and Written) – Advanced
• Domain Knowledge (Commercial US Insurance – Claims processing and code)
• Soft Skills Domain – Expert
• Language Enhancement Domain – Advanced
• Culture Sensitization Domain – Advanced
• Behavioral training – Intermediate/Advanced
• Evaluating others – Expert
• Coaching & Feedback – Expert
• Instructional Design – Advanced
• Facilitations Skills – Expert
• MS Office Skills – Advanced
• Flexibility, Integrity and Accountability – Expert
• Governance and Reporting - Advanced

Educational Requirement:

Minimum qualification of: BSC Biotech/Biology or BPharm Graduate

Experience Requirement:

Min. 3 years’ experience in managing New Hire Training and Coaching for US Commercial Healthcare Services with extensive experience in claim adjudication for a voice process.

Domain Requirements:

The candidate needs to adhere to the essential components of a comprehensive training program for staff in a healthcare or insurance setting. It covers orientation procedures, reference materials, insurance concepts, HIPAA and ARI protocols, plan document review, call handling techniques, claims processing, special benefits, departmental support functions, and call center operations. The candidate is required to run specific activities and share relevant knowledge areas that new team members should master to perform their roles effectively.

• Introduction and Orientation:

  Covers welcome messages, LMS courses, department expectations, email and document setup, and important reminders.

• Using Reference Materials:

  Includes cheat sheets, updated dental notes, Medicare write-ups, claims denials, and resolutions lists for use during training.

• Insurance Definitions and Concepts:

  Explains basics of health insurance such as deductibles, copays, out-of-pocket maximums, network types, claims submission, and precertification processes.

• HIPAA and ARI Procedures:

  Details of what information requires Additional Requested Information (ARI), how to send ARI emails, and related activities.

• Plan Document Familiarization:

  Activities include reading Summary Plan Descriptions (SPD), Base Camp exploration, scavenger hunts, and understanding benefit classifications.

• Call Handling and Verification:

  Training on verifying providers and members, using scripts, structuring call notes, and practicing verification of benefits (VOB) calls.

• Claims Processing and Denials:

  Covers claim lifecycle, searching claims, interpreting Explanation of Benefits (EOBs), denial types, claim corrections, and payment issues

• Special Benefits and Plans:

  Discusses preventive benefits, exclusions, vision benefits, prescription drug management, tiered plans, and special group protocols.

• Departmental Functions and Support:

  Overview of other departments such as IT, eligibility, claims, utilization review, and how to submit help desk tickets or transfer calls appropriately.

• Call Center Operations and Quality Assurance:

  Includes use of CRM systems, call recording reviews, note-taking, de-escalation techniques, phone system usage, auditing, QA scorecards, and error correction procedures.