Exec Services Senior Trainer

<p>With more than 7,000 employees, we are the largest health insurance company in Michigan. We offer an exciting work environment with a diverse group of employees. Our goal is to make health insurance easier for our members. We want to transform the industry and become a resource that people can trust.</p> <p><br /><br /><br /><br /><br /><br /></p>

Detroit, MI

Blue Cross Blue Shield of Michigan

When you think of <a href="https://www.bcbsm.com/" target="_blank" rel="noopener noreferrer">Blue Cross Blue Shield of Michigan</a> for health insurance, you can know you&rsquo;re getting much more. We're a company founded on a tradition of affordable, quality health care for everyone, improving the present and investing in the future.<br /><br />We offer:<br />Plans for employers and individuals that meet today&rsquo;s needs, budgets and lifestyle<br />The largest network of doctors and hospitals in the state<br />Lower health care costs Higher quality health care<br />Award-winning diversity practices<br />Grants and programs that promote better health throughout Michigan<br /><strong><br />Mission:&nbsp;</strong>We commit to being our members&rsquo; trusted partner by providing affordable, innovative products that improve their care and health.<br /><br /><a href="http://www.bcbsm.com/index/about-us/our-company.html" target="_blank" rel="noopener noreferrer"><strong>Click here</strong></a> to learn more about our commitment to our Social Mission, view company updates and reviews, and view our awards &amp; accolades.<br /><br />Learn more about your options as an external candidate. <a href="https://bcbsm.taleo.net/careersection/2/jobsearch.ftl?lang=en" target="_blank" rel="noopener noreferrer">Click here</a> to view open positions.&nbsp; http://www.bcbsm.com

keywords: professional,teamwork,analysis,maintain,compliance,administration,training,degree,experience,knowledge


Competitive Total Compensation Package

Overview: <strong><span style="font-size: small;">Develop and conduct formal classroom training, provide on-the-job training (OJT) for business area employees. Appraise employee performance to ensure departmental and corporate standards/objectives are met and adherence to state and federal laws and National Committee for Quality Assurance (NCQA) standards is maintained.</span></strong>
Responsibilities: <ul> <li>Identify internal departmental training needs such as documentation and response requirements, standards for meeting state and federal regulations, NCQA guidelines, functions, programs, tools, processes and systems, in consultation with management.</li> <li>Develop new approaches to training reflective of the changing marketplace and educate/train business area employees in handling basic to critical inquiries, complaints, and appeals and regulatory impacts on each appeal category ensuring consistency and adherence with corporate and divisional goals.</li> <li>Develop, maintain and update training manuals and packages, curriculums, CBTs, job aids and other materials.&nbsp; Develop and train verbal communication and conflict resolution techniques and telephone etiquette to those employees handling multiple hotlines within the business area for resolution of&nbsp; high level, critical problems, escalated issues, and clinically urgent appeals.</li> <li>Work with external areas to assess the changing landscape in health care and work closely with leadership to assess the training environment. Implement programs and policies for continued compliance in the Appeals and HIPAA space.</li> <li>Serve as subject matter expert (SME) for training with respect to HIPAA privacy and security provisions, NCQA elements, and state and federal law and regulations. Participate in special projects, representing the department/division and recommend changes/provide opinion.</li> <li>Provide in-depth training on departmental policies related to managing workload; appropriate action steps, timesaving techniques, overall evaluation/case resolution, and casual analysis.&nbsp; Coordinate administrative activities with leadership and the corporate training area.</li> <li>Review cases for accuracy of analysis, research, interpretation and documentation, conducting pre and post quality audits. Monitor the progress of cases for trainees on a daily basis, foresee possible problems in resolution and take immediate/necessary action to expedite cases, and mitigating delays to prevent missed deadlines.</li> <li>Serve as team leader when team leader is absent. Other duties may be assigned.</li> </ul>
Requirements: <ul> <li>Bachelor's Degree in Business, Education, Healthcare or related field required with course work in business writing, process improvement or project management preferred. Master's Degree preferred.</li> <li>Four (4) years BCBSM and/or related experience which must include specified years of experience in certain disciplines as designed by department.</li> <li>Proven experience in group presentations, leading and/or involvement in special projects, preparation of employees for job responsibilities through conducting OJT, performance evaluation feedback, coaching, etc.</li> <li>Strong analytical, organizational, planning and problem-solving skills.</li> <li>Excellent presentation, verbal and written communication skills. Understand and apply business-writing style.</li> <li>Proficient in current industry standard PC applications and systems.</li> <li>Maintain a comprehensive/current awareness and understanding of all benefits procedures, including marketing, bill and claims processing, underwriting, actuarial, and communicate to the department's personnel.</li> <li>Procedures for State/Federal regulated President's Hotline, 72 Hour Hotline, (Department of Insurance and Financial Services (DIFS), Managerial Level Conferences, Internal/External Expedited Grievances, Better Business Bureau, Regulatory Affairs, Litigation, appeals, grievances, complaints, for high level inquires, individual rights requests, etc.</li> <li>Other related skills and/or abilities may be required to perform this job.</li> </ul>