Responsible for training/coaching/auditing individual Claims Department staff on business processes/claims processing compliance as it relates to State contracts and department applications to achieve department goals and objectives. Works collaboratively with Team Leads and department leadership to develop and implement standard operating procedures. Serves as department subject matter expert for department specific software use and configuration.
5 to 7 years claims processing experience required.
Working knowledge of claim processing procedures and guidelines.
Working knowledge of claim adjudication and benefit plan application for HMO plans, Medicaid specific knowledge preferable.
Working knowledge of medical benefits and medical terminology.
Knowledge of commercial insurance provisions.
Proficiency in use of computer applications and typing speed (35 words per minute minimum.)
Experience with claims processing applications and business processes.
Strong skills in the following areas: oral and written communication, problem-solving, organization and time management, customer service, knowledge of adult teaching and learning, coaching, and auditing and reporting outcomes.