Medical Only Claims Specialist Trainer I/II

<strong>AF Group (Lansing, Mich.) and its subsidiaries are a premier provider of innovative insurance solutions. Insurance policies may be issued by any of the following companies within AF Group: Accident Fund Insurance Company of America, Accident Fund National Insurance Company, Accident Fund General Insurance Company, United Wisconsin Insurance Company, Third Coast Insurance Company, or CompWest Insurance Company.</strong>

Lansing, MI

AF Group

<p class="p1"><strong>AF Group&rsquo;s focused and passionate team uses industry-leading best practices, analytics and resources to manage risk and minimize loss for our policyholders while strengthening businesses with our valued independent agent partners.</strong></p> <p class="p1"><strong>We strive to continuously increase the long-term value of our organization by outperforming our industry peers and fostering a culture of underwriting and claims excellence.</strong></p> https://www.afgroup.com/

keywords: training,deliver,training,medical,analysis,support,performance,management,compliance,quality assurance,education,training,experience,knowledge,management,claims,skills

Full-Time

Competitive Compensation and Benefits Package

Overview: <p>Designs, delivers, and facilitates on-the-job training to employees within the Medical-Only Claims team. This position is primarily focused on the training needs of medical-only claim specialists and those who may support activities on these claims in the service center. The focus of this role is to deliver training on process changes, current or new procedures, workflows, compliance activities as well as jurisdictional and other educational topics to support claim outcomes and service levels. In addition, this position may be responsible for providing training to employees affiliated with Corporate and Brand Claims Operations.</p>
Responsibilities: <ul> <li>Works with Supervisors and Managers to conduct a training needs analysis of groups and individuals.</li> <li>Designs, develops, and delivers training plans, modules/courses, materials, and evaluations.</li> <li>Responsible for all areas of the deskside training process, including planning, scheduling, assessing skills or needs pre-training and post-training, coordinating and communicating training activities to the claims operations management team.</li> <li>Conducts most training in a one-on-one environment.&nbsp; May deliver to groups or online settings.</li> <li>Measures and evaluates training outcomes and effectiveness of training.</li> <li>Evaluates training compliance.</li> <li>Performs the responsibilities of the Medical Only Claim Specialist. May be required to perform other activities in other units to maintain or gain knowledge of current processes, procedures, and systems relative to the areas of training for which they are responsible.</li> <li>Ensures thorough training and follow up, assist in motivating Medical Only Claim Staff to engage in the application of the training provided and encourage understanding.</li> <li>May serve as a subject matter expert for Medical Only Claim Handling activities, claims intake, and assignment process.</li> <li>Understand the content of the S&amp;P Manual and be able to discuss and respond to process questions.</li> <li>Identify and troubleshoot potential system impacts and provide feedback to the Team and management as appropriate.</li> <li>Systematically develops, delivers, and continuously improves approach to repetitive training needs to ensure content is consistent between all trained staff.</li> <li>Coordinates regulatory changes and updates, assists in the monitoring of policies, practices, and procedures, and works closely with all claims managers to appropriately translate the updates to the end-user.</li> <li>Develops and maintains current documentation on Medical Only procedures, workflows, manuals, and educational updates.</li> <li>Conducts training for Maintenance and Limited Loss Time claims as appropriate.</li> <li>Attends monthly quality meetings with the MOCS Supervisors and MOCS Quality Specialist to address quality issues and to create action plans for improvement.</li> <li>Mentors and provides support to entry-level Medical Only Claim Specialists or ACT team members.</li> <li>Works with minimum supervision.</li> <li>May develop and deliver training for employees in Corporate and Brand Claims including but not limited to Intake and Investigative Services.</li> </ul> <p><strong>Additional Responsibilities of Medical Only Claims Specialist Trainer II:</strong></p> <ul> <li>Mentors and provides support to the Medical Only Claim Specialists team.</li> <li>Participates in the development of annual department education goals, objectives, and budget for training needs.</li> <li>Conducts complex training needs analysis.</li> <li>Designs, develops, and delivers complex training plans, modules/courses, materials, and evaluations.</li> <li>Assists in the implementation of changes within the function/organization based on training compliance evaluations. Delivers training for multiple staff positions.</li> </ul>
Requirements: <p><strong>EDUCATION REQUIRED:&nbsp;</strong></p> <p><strong><u>Medical Only Claims Specialist Trainer I:</u></strong></p> <p>Associate degree in Insurance, Communications, Education, Business, or related field.&nbsp; Claims adjuster license for the State of Michigan or a Designated Home State Adjuster License. Combinations of education and experience may be considered instead of a degree and/or certification.</p> <p><strong><u>Medical Only Claims Specialist Trainer II:</u></strong></p> <p>Bachelor&rsquo;s degree in Insurance, Communications, Education, Business or related field. Insurance designations such as CPCU, AIC, or ARM, or completion and passing of CAWC course. Claims Adjuster License for the State of Michigan or a Designated Home State Adjuster License.&nbsp; Combinations of education and experience may be considered instead of degree and/or certification.&nbsp;</p> <p><strong>EXPERIENCE REQUIRED:</strong></p> <p><strong><u>Medical Only Claims Specialist Trainer I:</u></strong></p> <p>Minimum of five (5) years of medical-only or lost time claims adjuster experience, including two (2) years developing and delivering training, or equivalent experience that provides the necessary skills, knowledge, and abilities.</p> <p><strong><u>Additional Experience of Medical Only Claims Specialist Trainer II</u></strong></p> <p>Two (2) years of experience as a Medical Only Claims Specialist Trainer I.</p> <p><strong>OR</strong></p> <p>Minimum (7) years of medical-only or lost time claims adjuster experience, including four (4) years developing and conducting training. Group training and experience with learning and education technology tools required. Equivalent experience that provides the necessary skills, knowledge, and abilities may be considered.</p> <p><strong>SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:&nbsp;</strong></p> <ul> <li>Excellent verbal, written communication, and presentation skills with an emphasis on creating a dynamic training presentation, instructions, checklists, and illustrations.</li> <li>Strong technical knowledge and understanding of workers&rsquo; compensation rules and regulations.</li> <li>Ability to demonstrate good judgment and sound decision-making abilities.</li> <li>Ability to manage deadlines and solving problems timely.</li> <li>Ability to research jurisdictional questions for proper answers.</li> <li>Ability to use reference material and apply information to medical-only claims, long-term maintenance claims, or those claims being transferred to indemnity.</li> <li>Thorough knowledge of Workers Compensation Compliance Rules and jurisdictional requirements on medical-only claims in multiple states (example: statutes).</li> <li>Thorough knowledge of workers&rsquo; compensation claims processing methodologies, including Maintenance and Limited Loss Time.</li> <li></li> <li>Ability to establish a personal rapport at all levels of the organization, especially internal customers.</li> <li>Ability to manage multiple priorities, establish workflows and meet necessary deadlines.</li> <li>Ability to comprehend the broad application of the corporate goals and effectively communicate their relationship to departmental and individual training objectives.</li> <li>Knowledge of computers, word processing, presentation, and spreadsheet software.</li> <li>Excellent organizational skills and ability to prioritize work.</li> <li>Ability to use reference manuals and conduct research.</li> <li>Ability to perform mathematical calculations.</li> <li>Ability to proofread documents for accuracy of spelling, grammar, punctuation, and format.&nbsp;</li> <li>Knowledge of the Workers Compensation Act and Claims process.</li> <li>Ability to modify the approach to training including delivery style to accommodate varied adult learning styles.</li> <li>Ability to type 40 wpm.</li> </ul> <p><strong>ADDITIONAL SKILLS/KNOWLEDGE/ABILITIES REQUIRED &ndash; Medical Only Claims Specialist Trainer II:</strong></p> <ul> <li>Ability to coach and mentor other staff.</li> <li>Ability to read, analyze and interpret complex data to determine trends or problems and make recommendations.</li> <li>Demonstrated competency in developing and delivering training for workers compensation claim professionals.</li> <li>Demonstrated competency in developing and training on new processes, content, procedures, and systems.</li> <li>Ability to identify complex training needs, review related information and develop options and solutions.</li> <li>Ability to establish a personal rapport at all levels of the organization, including external customers and managers, and ability to resolve conflicts professionally.</li> <li>Thorough knowledge of departmental procedures and workflows and job duties/tasks for which they are assigned.</li> <li>Thorough knowledge of the Workers Compensation Act and Claims process.</li> </ul> <p><strong>ADDITIONAL EDUCATION, EXPERIENCE, SKILLS, KNOWLEDGE, AND/OR ABILITIES PREFERRED:</strong><em>&nbsp;</em></p> <p><strong><u>Medical Only Claims Specialist Trainer I</u></strong></p> <ul> <li>Completion of industry-recognized training seminars or Insurance designations such as CPCU, ARM, or CAWC.&nbsp;</li> <li>Experience developing online learning and using learning management systems.</li> </ul> <p><strong><u>Medical Only Claims Specialist Trainer II</u></strong></p> <ul> <li>Progress toward, or completion of, industry-recognized training professional designation.</li> <li>Proficiency with Guidewire Claims Center, PowerPoint, Learning, and Talent Management Systems.</li> </ul>