evry-health - Evry Health - Operations Trainer

Remote - CT (Central)4w ago

Remote Mid NA Health Insurance Insurance Training Specialist Instructor Coaching Customer Training Training Development Zoom Microsoft Teams

Requirements

• Bachelor’s degree in Business, Healthcare Administration, Education, Communication, or a related field; or equivalent work experience. • 3–5 years of experience in health plan operations (claims and/or customer service); minimum 2-4 years in a training, coaching, or instructional role. Strong preference for background in operations and contact centers. • Claims Knowledge • Working knowledge of claims adjudication, appeals/grievances, EOBs, ICD-10/CPT coding. Texas Insurance Code knowledge is a plus. • Demonstrated expertise in contact-center operations including call quality, and member/provider communication standards (both verbal and written). • Virtual Facilitation • Proven ability to engage and manage remote audiences via Zoom, Microsoft Teams, or equivalent video-conferencing platforms. • System Proficiency • Experience with Salesforce, Vonage, and/or comparable CRM, telephony, and health plan platforms. • Exceptional written and verbal communication skills; ability to translate complex regulatory and clinical content into plain-language training. • Strong project-management skills with the ability to manage multiple training cohorts, deadlines, and content-revision cycles simultaneously. • Certification in instructional design, adult learning (CPLP, ATD), or a related credential. • Experience with e-learning authoring tools such as Articulate 360, Rise, or Adobe Captivate. • Familiarity with CMS Star Ratings, NCQA, or URAC accreditation standards. • Prior experience supporting UAT, system rollouts, or technology implementation projects. • Background in employer-sponsored health plan administration/ Commercial health insurance. • Experience building and administering knowledge-check assessments with scoring rubrics. • ## Work Environment • Fully remote; home office with reliable high-speed internet required. • Core hours align with CST/EST business hours • Evry Health-issued laptop, headset, and collaboration tools provided. • Physical Demands • Prolonged periods of sitting and working at a computer; virtual facilitation for extended sessions. • Daily interaction with Operations leadership, HR, IT, and vendor partners via virtual channels.

Responsibilities

• Training Delivery & Facilitation • Virtual Facilitation: Deliver engaging, interactive training sessions via Teams platform for new hires and tenured staff covering product knowledge, soft skills, and systems navigation. • New-Hire Onboarding: Lead structured onboarding programs covering Evry Health’s products, systems, workflows, policies, and member-centric service standards. • Role-Play & Simulation: Design and facilitate live role-play scenarios that mirror real customer interactions, claims inquiries, and escalation situations. • Blended Learning: Combine synchronous instructor-led sessions with asynchronous e-learning modules, job aids, and recorded content. • Competency Verification: Administer knowledge checks, quizzes, and skills assessments to confirm learner readiness before live deployment. • Post-Training Monitoring- Monitor staff performance; identify training gaps and deploy targeted interventions to address deficiencies quickly • Change Communication Support- Collaborate with Operations leadership to craft clear, timely change communications that prepare agents for upcoming system or workflow transitions. • Claims Operations Training • Claims Processing Fundamentals: Train staff on end-to-end claims lifecycle, adjudication, issue identification and remediation, including testing outcomes, denial, adjustment, and dispute procedures. • Regulatory Compliance: Deliver training on Texas Insurance Code Chapter 1467, prompt-pay requirements, IDR processes, and CMS guidelines. • Coding & Billing Basics: Provide foundational instruction on ICD-10, CPT, HCPCS, and modifier usage as it relates to claims review and provider disputes. • Dispute & Appeal Workflows: Train staff on internal and external dispute resolution processes, timelines, and documentation requirements. • Customer Service Operations Training • Contact Center Standards: Train agents on Evry Health’s call-handling protocols and quality expectations. • Member & Provider Communication: Coach staff on professional, empathetic communication. • Correspondence Turnaround: Reinforce 1-business-day (member) and 2-business-day (provider) correspondence turnaround standards and documentation requirements. • Escalation Handling: Build staff confidence in identifying, documenting, and escalating complex or sensitive cases to supervisory and clinical teams. • Quality Assurance Alignment: Align training content with QA audit rubrics covering call quality, case accuracy, and documentation standards. • Curriculum Development & Content Management • Training Material Creation: Develop and maintain SOPs, job aids, desk-top procedures, e-learning modules, and quick-reference guides for all operational workflows. • Knowledge-Check Design: Build comprehensive knowledge assessments with scoring rubrics aligned to benefit program content and operational standards. • Content Updates: Promptly revise training materials in response to regulatory changes, system updates, or operational policy revisions. • Learning Management Administration: Upload, organize, and track training completion records. • Reporting & Analytics: Generate training completion reports, assessment score summaries, and gap-analysis data for Operations leadership. • SME Collaboration & Curriculum Development: Partner with subject matter experts across Claims and Customer Service Operations to capture process knowledge, workflow nuances, and performance expectations, then translate that expertise into role-specific curriculum with the level of detail required for staff to accurately and confidently perform their job functions. • Documentation Standardization: Review and restructure existing Desktop Procedures (DTPs) and current operational documentation, consolidating and reformatting content into a consistent, standardized format aligned with Operations’ style and readability requirements.