Process Lead, Claims

2 months ago

Boise, United States CHCS Services, Inc Full time

At CHCS Services, we are committed to providing innovative healthcare solutions while fostering a supportive and inclusive work environment for our employees. We can succeed together as a team by investing in our employees' well-being and professional development. Thank you for considering CHCS Services for your healthcare needs and employment opportunities.

 Job Summary 

A process leader leads, monitors, and administrates a group of employees to achieve goals that contribute to the organization's growth. Process leaders motivate and inspire their teams by creating an environment that promotes positive communication, encourages bonding of team members, and demonstrates flexibility. 

 Responsibilities 

Working with the Claims Manager provides daily direction and communication to employees so that the business deliverables are intact, efficient, and knowledgeable manner. 

- Monitoring operational activities of claim examiners to ensure claims are processed accurately and timely.  - Provide technical support, expert advice, and coaching assistance to team members and clients.

- Identify new opportunities to improve operational effectiveness and customer satisfaction and make recommendations for improvements.  - Identify skill gaps and ensure training is provided to further develop staff.  - Should be aware of KRAS, KPIS, SLA, AHT, Occupancy, Attrition, and Shrinkage.  - Should be able to manage team conflict and any people-related issues  - Should have experience and be able to handle complaints, DOI, Appeal, etc.  - Adhere to process reporting, able to draft process documents, including SOP, Update tracker, issue logs , etc.  - Ability to do the quality audit for team process   - Ability to speak to client on process related issues and able to handle the calls with client 

Qualifications  -To perform this job successfully, the individual must be able to perform each essential duty effectively.  

- The individual must possess advanced product knowledge, a comprehensive understanding of insurance terminology and definitions, and core knowledge of company and department processes and procedures related to the ability to complete job responsibilities /duties proficiently and professionally.   

- Must have knowledge of medical terminology, ability to read and interpret most medical records/notes, ICD-9/10 and CPT/HCPC/CDT coding; Familiarity with different medical claim forms, i.e. HCFA-1500 and UB04 forms; working knowledge of Insurance Industry and/or Healthcare.  

Education -Experience  One to Two years certificate/degree from college or technical school; or 2-5 years related experience and/or training; or equivalent combination of education and experience.  

Language Skills Must have the ability to read and interpret documents such as policies and operating and procedural manuals; Ability to write routine correspondence; Ability to speak effectively to customers, clients, or employees of the organization.    Competencies  Critical Thinking; Customer Service; Work Standards; Decision-Making; Communication; Interpersonal Skills; Integrity/Honesty and Adaptability/Flexibility   Mathematical Skills   Must have the ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals; Ability to calculate figures and amounts such as discounts, interest, and percentages. 

Reasoning Ability  Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form; Ability to deal with problems involving several concrete variables in standardized situations.  

   Standard Company Requirements:

  • Collaborative team spirit.
  • Accountable and able to work remotely and independently.
  • Able to pass background screening and drug tests pre and post-hire – includes THC
  • Verification of high school, GED, or college diploma upon request.
  • Timely responses from three professional references. 
  • Able to provide a dedicated remote work location free from background noises, interruptions, and desk clutter.
  • Able to provide an ongoing reliable internet connection and access to a smartphone for Multi-Factor Authentication and communication purposes.

  Work Environment 

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.  

Physical Requirements: 

  • The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
  • While performing the duties of this job, the associate is frequently required to sit; use hands, fingers, handle, or feel; and talk or hear.  The employee is occasionally required to stand; walk; reach with hands and arms; climb or balance; and stoop, kneel, crouch, or crawl.  The associate must occasionally lift and/or move up to 15 pounds.  Specific vision abilities required by this job include close vision, distance vision, color vision, and the ability to adjust focus. The associate must be able to present and speak simultaneously in meetings.
  • Prolonged periods sitting at a desk and working on a computer and phone line usage.
  • Ability to read, hear, speak, keyboard, reason, and problem solve.
  • Requires the use of office equipment such as computer terminals, telephones, or copiers.
  • Close visual acuity to perform activities such as: preparing and analyzing data, transcribing, viewing a computer terminal, and extensive reading.

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