Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nations largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.
Mission: L.A. Cares mission is to provide access to quality health care for Los Angeles County’s vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
Job Summary
The Claims Training Specialist II is primarily responsible for designing and conducting training programs using established departmental guidelines. This position is responsible for providing ongoing training on the core processing system, claims processing procedures, communicating regulatory changes which will affect established procedures, establishing quality and performance guidelines, creating and maintaining departmental policy and procedures, and working with the Claims Compliance Manager to monitor and track individual performance.
Duties
Build competencies for the Claims Department by designing and conducting training programs that will boost employees workplace performance in alliance with Enterprise and departmental goals. Responsible for performing training needs assessments with the Claims Compliance Manage and will assist in designing and delivering curriculum and learning materials to ensure the success of new and current Claims Examiners.
Work with document specialists to create training presentations and with Human Resource to customize training for inclusion into the L.A Care University.
Quality review of processed claims. Develop and create reports to determine area of improvement in claims processing for department.
Researching provider and member grievances to identify error trends and training opportunities. Create and develop tracking and trending mechanisms to identify type of grievances/ complaints for Claims Department.
Conduct assessments after training to measure, record, and report feedback on training material and sessions. Serve as coach for all Claims Examiners to handle problems and concerns as they arise.
Review and recommends updates on policy and procedure critical to claims process.
Perform other duties as assigned.
Education Required
Education Preferred
Experience
Required:
At least 4 years of claims processing and training and facilitation experience in a Managed Care environment with the demonstrated experience on the following list of stated knowledge and/ or skills.
Extensive hands on experience in the design and delivery of training.
Preferred:
Supervisory experience
Skills
Required:
Proficient using Word, Excel, and Access.
Knowledge of CA regulatory guidelines, Medi-Cal rules, CPT/ICD-10 coding, CMC lob.
Excellent written and verbal communications skills
Licenses/Certifications Required
Licenses/Certifications Preferred
Required Training
Additional Information
L.A. Care offers a wide range of benefits including
- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
- Volunteer Time Off (VTO)
At L.A. Care, we value our team members safety. In order to keep our work locations safe, each employee is required to self-screen for symptoms prior to entering any L.A. Care location each day. L.A. Care and all of its staff are required to comply with all state and local masking orders. Therefore, when on-site at any L.A. Care location, employees are expected to wear a mask in areas where physical distancing cannot be managed.