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Member Services Trainer/Auditor

Sapphire Digital

Sapphire Digital

Multiple locations
Posted on Thursday, May 23, 2024

Position Overview

The Member Services Trainer/Auditor is a vital role in ensuring service excellence to Open Access Pricing clients and their members. The Trainer/Auditor will be responsible for designing, developing, implementing, and delivering training to internal and external partners for all Member Advocacy functions and activities.

This role is also responsible to ensure reference materials are current and align with training materials, policies, procedures, and system usage. All training will be developed in accordance with approved policies and procedures, and system design and technical documentation for all Open Access Pricing systems and product offerings. The Member Services Trainer/Auditor is a subject matter expert (SME) for Advocacy Operations and may back-fill for other positions as needed.

Key Responsibilities

  • Manage external vendor auditing, training, and feedback procedures

  • Work closely with operations and support leadership on performance auditing to foster development of internal associates

  • Design and deliver training programs including new hire training, remedial or refresher training, and client training

  • Formulate training curriculum, develop targeted instructional methods such as individual training, group instructions, demonstrations, and workshops

  • Develop and maintain training materials such as handbooks, manuals, multimedia visual aids, computer tutorials, reference tools, and eLearning

  • Develop methods to measure progress and to evaluate effectiveness of training and means for suggested improvements by trainees

  • Incorporate new policies, procedures, technologies, and business initiative into training materials

  • Develop and maintain knowledge repository and training records

  • Partner with IT developers to assist with User Acceptance Testing for system modification and new system capabilities as needed

  • Conduct procedural and systems audits of completed provider outreach requests, balance bill resolution, navigation support, NSA negotiations, and phone calls

  • Assess audit tools, forms, and calculations as needed for new product offerings and system modifications

  • Calculate individual, team, and department audit results from standard criteria, targeted audits, new hire audits, etc. Create and provide reports and statistics to leadership based on audit findings

  • Identify opportunities and recommend methods to improve service, work processes, and financial performance

  • Comply with HIPAA regulations and ensure confidentiality of calls, documents, and other sensitive information

Required Qualifications

  • Associate degree or higher

  • At least 12 months performance in the Advocacy Operations Senior Advocate, Advocacy Operations Team Lead, or other equivalent Advocacy Operations role

  • 2+ years of experience in technical training, adult learning, or talent management

Preferred Qualifications

  • Experience building out learning processes and structure with various technology platforms and tools

  • Experience with Medicare reimbursement, and various reimbursement methodologies, and benefit calculations

  • Knowledge of healthcare insurance and industry principles

  • Experience implementing process improvement

  • Excellent customer service skills with experience managing escalated issues

    As a leading payments company in healthcare, we guide, price, explain, and pay for care on behalf of insurers and their members. We’re Zelis in our pursuit to align the interests of payers, providers, and consumers to deliver a better financial experience and more affordable, transparent care for all. We partner with more than 700 payers, including the top-5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, over 4 million providers, and 100 million members, enabling the healthcare industry to pay for care, with care. Zelis brings adaptive technology, a deeply ingrained service culture, and a comprehensive navigation through adjudication and payment platform to manage the complete payment process.

    Commitment to Diversity, Equity, Inclusion, and Belonging
    At Zelis, we champion diversity, equity, inclusion, and belonging in all aspects of our operations. We embrace the power of diversity and create an environment where people can bring their authentic and best selves to work. We know that a sense of belonging is key not only to your success at Zelis, but also to your ability to bring your best each day.

    Equal Employment Opportunity
    Zelis is proud to be an equal opportunity employer. All applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

    We encourage members of traditionally underrepresented communities to apply, even if you do not believe you 100% fit the qualifications of the position, including women, LGBTQIA people, people of color, and people with disabilities.

    Accessibility Support

    We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email TalentAcquisition@zelis.com

    SCAM ALERT: There is an active nationwide employment scam which is now using Zelis to garner personal information or financial scams. This site is secure, and any applications made here are with our legitimate partner. If you’re contacted by a Zelis Recruiter, please ensure whomever is contacting you truly represents Zelis Healthcare. We will never asked for the exchange of any money or credit card details during the recruitment process. Please be aware of any suspicious email activity from people who could be pretending to be recruiters or senior professionals at Zelis.