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Professional - Non-Clinical
Claims Audit Educator
Houston, TX, US
We’re looking for a Claims Educator, someone who’s ready to grow with our company. In this position you will lead in the design, development, and implementation of training programs for new and existing employees, to enhance the competency, performance and professional development of the Claims Administration team. This position is critical in the development and ongoing accuracy of claims processing to ensure accurate reimbursement to Providers.
Think you’ve got what it takes?
Job Duties & Responsibilities
• Develops and coordinates the Claims Administration Training Program.
• Designs and Develops Training manual and desktop procedures to encompass the major areas of Claims Administration including data entry, mailroom and claims examination. Conducts training program to provide an effective and interactive learning environment to achieve departmental goals and objectives utilizing innovative, professional communication methods.
• Assures that staff completes Health Plan and departmental orientation upon employment as monitored by training records. Documents competency scores for Pre & Post Assessments to ensure comprehension of material presented to employees.
• Provides staff with ongoing job-specific training programs, in services and continuing education opportunities.
• Develops and completes measurable job-specific training as identified by statistical reports and audits.
• Collects and evaluates feedback on training program initiatives and makes recommendations for improvement.
• Completes audits, consistent with industry standards, of each claim examiner/specialist trainees' completed throughout the course training and within the nesting period.
• Completes audits of post ad-hoc or refresher training claim processing.
• Supports the development and action plan follow-up for individuals as required.
• Provides Information System Application Expertise.
Skills & Requirements
• H.S. Diploma or GED Required
• 4 years previous training experience in an adult training environment required
• A bachelor's degree may substitute for two (2) years of the required experience
About Texas Children’s
Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.
To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities.
Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
