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Claims Trainer
Personify Health. Design and deliver instructor-led, virtual, and self-paced examiner training .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in designing and delivering training programs for health insurance claims, with a strong focus on regulatory compliance and quality assurance. Proficient in developing procedural documentation and training materials that align with industry standards and operational needs.
Highest-signal resume keywords
Health Insurance Claims ProcessingTraining Curriculum DevelopmentRegulatory Compliance (CMS, HIPAA, ERISA)Claims Examiner CertificationInstructional Design
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims ProcessingAdjudication LogicBenefit InterpretationStandard Claims Coding (CPT, HCPCS, ICD-10)Process MappingQuality AuditingVersion ControlTraining DeliveryDocumentation AuthoringError Trend Analysis
Soft Skills
Organizational SkillsCommunication SkillsCollaborationProblem-SolvingLeadership
Tools & Technologies
LMS Platforms (Cornerstone, Workday Learning)Process-Mapping Tools (Visio, Lucidchart)Documentation Tools (SharePoint, Confluence)Core Claims Platforms (Javelina, ElDorado, QicLink, Facets)
Certifications & Qualifications
Claims Examiner CertificationSix Sigma Certification
Industry Keywords
Medicare AdvantageMedicaidASO/Self-Funded ClaimsState Prompt-Pay LawsQuality Improvement
About the role
Key responsibilities & impact- Design and deliver instructor-led, virtual, and self-paced examiner training
- Cover adjudication logic, benefit interpretation, coordination of benefits, and system navigation
- Manage session scheduling, progress tracking, and certification
- Partner with Quality Audit to convert error trends into targeted refresher training
- Train team leads and subject-matter experts to deliver training
- Track quality, productivity, and turnaround time against training outcomes
- Build and launch training for new lines of business, system rollouts, and platform migrations
- Author and maintain claims procedures, workflow guides, and job aids
- Translate regulatory, policy, and configuration updates into same-day guidance
- Maintain a version-controlled procedure library
- Validate procedures against state, federal, ERISA, and CMS requirements
- Build process flow diagrams and decision trees for complex claims
- Validate training and procedure content against live system benefit configuration
- Coordinate go-live readiness with IT and platform vendors
- Provide organized documentation for regulatory exams and internal reviews
- Surface process, training, and documentation gaps to Claims Operations leadership
Requirements
What you’ll need- 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
- 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
Comp & perks- Competitive base salary
- Benefits effective day one
- Comprehensive medical and dental coverage
- Unlimited PTO
- Mental health support
- Retirement planning
- Financial protection
- Professional development
- Clear career progression
- Learning budgets
- Wellness programs
- Other employee perks
- Mission-driven culture where diverse perspectives drive real impact