Claims Trainer

Every adjudication rule, benefit configuration, and compliance requirement is only as good as the examiner's ability to apply it correctly under pressure. This role is where that knowledge gets built — turning dense policy and regulatory change into training and desk-level procedures that examiners can pick up and use the same day. When training lands well, claims get processed faster and more accurately, error trends get caught and corrected before they compound, and new lines of business or system migrations go live without chaos on the floor. That has a direct line to client trust and member outcomes: accurate claims mean fewer denials to appeal, fewer delays to explain, and fewer surprises for the people counting on their coverage. The quality of this training becomes the quality of every claim it touches.

Design and deliver examiner training: Build and run instructor-led, virtual, and self-paced sessions covering adjudication logic, benefit interpretation, coordination of benefits, and system navigation for examiners, analysts, and support staff.

Own classroom logistics and certification: Manage session scheduling, progress tracking, and certification so training runs smoothly from start to finish.

Convert audit findings into fast coaching: Partner with Quality Audit to identify error trends and turn them into targeted refresher training before small issues become recurring ones.

Build training capability in team leads: Train the trainers — equip team leads and subject-matter experts to deliver training themselves so knowledge doesn't bottleneck with one person.

Measure training against production results: Track quality, productivity, and turnaround time against training outcomes, and adjust curriculum when the numbers aren't moving.

Stand up training for new initiatives fast: Build and launch training for new lines of business, system rollouts, and platform migrations on tight timelines.

Author claims procedures and job aids: Write and maintain workflow guides and procedures clear enough to follow under real production pressure.

Translate policy changes into same-day guidance: Turn regulatory, policy, and configuration updates into plain-language documentation examiners can apply immediately.

Maintain a current procedure library: Keep documentation version-controlled and up to date with benefit changes, coding updates (CPT, HCPCS, ICD-10, revenue codes), and system releases.

Validate compliance with Legal and Compliance: Confirm every procedure document reflects current state, federal, ERISA, and CMS requirements.

Map the claims that don't follow a simple path: Build process flow diagrams and decision trees for complex or exception-driven claims scenarios.

Validate content against live system configuration: Check training and procedure content against Configuration's system-loaded benefit plans before anything goes live.

Coordinate go-live readiness with IT and vendors: Partner with IT and platform vendors so documentation is ready before go-live, not scrambled together after.

Support audits with organized documentation: Provide accurate, audit-ready documentation on request for regulatory exams and internal reviews.

Surface gaps before they become problems: Act as the link between Claims Operations leadership and the frontline, flagging process, training, or documentation gaps early.

What You Bring to Our Team

Education & Experience:

Bachelor's degree or equivalent experience in health insurance claims

5+ years processing, auditing, or configuring health insurance claims across medical, dental, and vision

3+ years building or delivering training curriculum or technical/procedural documentation, ideally at a health plan or managed care organization

Experience with Medicare Advantage, Medicaid, or ASO/self-funded claims

Claims examiner certification background a plus

Technical Skills:

Working knowledge of core claims platforms (Javelina, ElDorado, QicLink, Facets, or similar)

Working knowledge of standard claims coding (CPT, HCPCS, ICD-10, revenue codes)

Working knowledge of CMS guidelines, state prompt-pay laws, HIPAA, and ERISA

Instructional design background and familiarity with LMS platforms (Cornerstone, Workday Learning) preferred

Experience with process-mapping and documentation tools (Visio, Lucidchart, SharePoint, Confluence) preferred

Six Sigma or quality improvement background a plus

Benefits

Competitive base salary and benefits effective day one

Comprehensive medical and dental through our own health solutions (yes, we use what we build)

Unlimited PTO—rest and recharge time is non-negotiable

Mental health support, retirement planning, and financial protection

Professional development with clear career progression and learning budgets

Mission-driven culture where diverse perspectives drive real impact on people's health

Want the full picture? Visit personifyhealthbenefits.com to explore our complete benefits package, wellness programs, and other employee perks.