Summary of Position

Facilitate Grievance and Appeals training programs: may collaborate with Lead / Manager to evaluate, research, select, and develop content as appropriate. Responsible for multiple training topics related to Grievance and Appeals: Products; Guidelines; polices & procedures; and systems utilized by G&A staff. May create content and training materials; directly deliver training sessions, in person and/or virtually. Evaluate and maintain training programs and materials to ensure they are current and effective. Utilize direct trainee feedback and other metrics to determine training efficacy; provide recommendations for program and training content improvements.

Principal Accountabilities 

Facilitate delivery (in-person and virtual) of product, process, and systems courses across G&A as business needs dictate for new hire, upskilling or refreshers; with class sizes varying from individual to large groups (up to 20).  Deliver content, leverage engagement, use deeper questioning and effective classroom management techniques. Observe learners and provide constructive feedback. View topic assessment data and adjust training real-time as necessary. Support training activities, assisting with questions and encouraging learners to find answers themselves. Leverage class feedback and manager observations to identify areas for improvement. Work with stakeholders, SMEs, and others to design and develop training material to ensure accuracy and to ensure delivery reflects best practices to support the overall current training requirements as well as changes that need to be incorporated.  Lead the design, development, and delivery of targeted training courses for specific G&A functionalities. Utilize monthly audit results to determine new training opportunities to increase understanding of business processes. Obtain and interpret feedback of results to determine if training was effective, and to identify opportunities to improve materials, coursework, and assessments. Perform independent research to maintain awareness of best practices, and to locate articles, courses, etc. Maintain mastery level of understanding of all Enterprise products, G&A systems, and policies & procedures required for the G&A department– and seek opportunities for deeper knowledge. Develop resources to assist training department to strengthen training tools. Participate in activities that look at new processes, systems, etc. to support corporate initiatives with an eye towards identifying opportunities to improve processes within G&A. Evaluate training’s impact and results in the business units and in training; reports findings and make a significant contribution to planning and other core processes Perform all other duties as assigned.

Qualifications 

Bachelor’s Degree
3 – 5+ years’ relevant, professional work experience Proven experience in various types of training: hands-on, virtual, classroom, and large audience settings Proven ability to design, develop, and deliver effective training materials, processes, and sessions Additional related experience/specialized training may be considered in lieu of educational requirements Knowledge of adult learning theory Excellent communication skills (verbal, written, presentation, interpersonal/relationship building) Excellent organizational, decision-making, problem identification and resolution, and time management skills Strong knowledge of grievance and appeals day to day operations Proficiency with MS Office (Word, Excel, PowerPoint, Outlook) Growth oriented, self-motivated, innovative, and flexible Ability to follow instructions, procedures, and assignments accurately within a set time frame and to function under stressful situations, in a calm and rational manner Ability to work effectively with wide range of audiences under training project and ad hoc conditions Knowledge of NCQA regulations, state, and federal guidelines for the processing of member/provider correspondence Additional Information Requisition ID: 1000002655 Hiring Range: $56,160-$99,360