Customer Solutions Center Appeals and Grievances
4 weeks ago
**Title:**:Customer Solutions Center A&G Training Specialist II
**Status**: Full-Time, Hybrid
**Location:**:Los Angeles, California
**Salary**: $77,265 - $100,445
**Bonus**: 4% incentive bonus and merit increase yearly
**Sponsorship**: No visa sponsorships are supported
**_ **Position will be Hybrid - will be conducting combination WebEx and in near future Onsite Trainings. Must be flexible. Person will need to be working in state remote when working from home.**_**
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**Job Summary**:
The Customer Solutions Center Appeals and Grievances (A&G) Training Specialist II is primarily responsible for the overall training strategy across the department. This position designs and conducts training programs using established regulatory and departmental guidelines. This position is responsible for providing ongoing training on the core processing system, A&G processing procedures, training regulatory changes which will affect established procedures, working with the quality team on quality and performance guidelines, creating and maintaining departmental policy and procedures. Additional responsibilities include evaluating initial training and ongoing learning opportunities to achieve consistency, efficiency, and productivity among the staff.
**Essential Responsibilities**:
**Training Program Design**: Use skills to create training programs that improve employee performance according to company goals. Collaborate with department managers to identify training needs and develop curriculum and materials for new and current staff.
**Training Delivery**: Conduct training sessions for the Customer Solution Center team on customer service, product operations, and other job processes. Cover various topics such as computer use, interpersonal skills, quality standards, and product knowledge.
**Documentation and Compliance**: Maintain records of training activities, including updating databases, creating agendas, and tracking attendance to ensure compliance with department requirements.
**Performance Monitoring and Improvement**: Work with stakeholders to track errors, productivity, and quality standards. Identify skill gaps and recommend training measures to improve staff performance. Propose program adjustments to enhance results and member satisfaction.
**Assessment and Feedback**: Evaluate training effectiveness through post-training assessments and gather feedback. Support staff as they address problems and concerns.
**Policy and Procedure Updates**: Review and suggest updates to policies and procedures related to claims processing.
**Other Responsibilities**: Complete any other assigned tasks as needed.
**Job Qualifications**:
**Experience**:
- A minimum of 3-5 years of Managed Care, Medicaid, Medicare experience required.
- A minimum of 3-5 experience in design and delivery (facilitating and coordinating) of training programs.
- Appeals & Grievances experience - preferably as Lead (preferred)
**Education**:
- Bachelor's Degree in Business Administration or Healthcare Related Field
In lieu of degree, equivalent education and/or experience may be considered.
**Required Skills**:
- Strong understanding of learning principles and ability to demonstrate in classroom (or virtual classroom) situations.
- Knowledge of CA regulatory guidelines, Medi-Cal guidelines, Medicare guidelines, NCQA requirements.
- Skilled in group facilitation and managing effective discussion and dialogue to enhance the learning experience
- Strong organizational & analytical skills.
- Ability to conduct effective and engaging presentations in a variety of delivery settings.
- Ability to interpret technical data, processes, operating and maintenance instructions and procedure manuals.
- Must be a strong team player willing to work toward achieving team goals. Must be flexible to meet the changing training needs.
- Professional demeanor. Commitment to Team Culture.
- Excellent written and verbal communications skills.
- Proficient using Word, Excel, Power Point and Access
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