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Customer Solution Center Appeals and Grievances Training Specialist II

Customer Solution Center Appeals and Grievances Training Specialist II

locationLos Angeles, CA 90017, USA
PublishedPublished: 12/8/2023

Salary Range:  $77,265.00 (Min.) - $100,445.00 (Mid.) - $123,625.00 (Max.)

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

Job Summary

The Customer Solutions Center Appeals and Grievances (A&G) Training Specialist II is primarily responsible for the overall training strategy across the department. This position designs and conducts training programs using established regulatory and departmental guidelines. This position is responsible for providing ongoing training on the core processing system, A&G processing procedures, training regulatory changes which will affect established procedures, working with the quality team on quality and performance guidelines, creating and maintaining departmental policy and procedures. Additional responsibilities include evaluating initial training and ongoing learning opportunities to achieve consistency, efficiency, and productivity among the staff.

Duties

Applies knowledge and skills to build competencies for the design of training programs that will boost employee’s workplace performance in alliance with Enterprise and departmental goals. Responsible for performing training needs assessments with the department management and will leads the design and delivery of  curriculum and learning materials to ensure the success of new and current staff.

Conducts training for Customer Solution Center A&G team in customer service, product operations, and other work processes. Conducts training sessions covering specified areas such as on-the-job training, use of computers and software, interpersonal skills, quality & process issues, and product knowledge.

Maintain documentation, including database/system updates, training agendas, sign-in sheets, etc. to demonstrate trainee compliance with department requirements.

Work with key stakeholders to monitor error trends, productivity, and quality standards for the program. Identifies gaps in knowledge, skills and abilities, assess and recommend training/education measures to resolve issues and enhance staff performance.

Propose program modifications to enhance performance and positively influence member satisfaction survey results.

Conduct assessments after training  to measure, record, and report feedback on training material and sessions. Serve as coach staff to handle problems and concerns as they arise.

Review and recommends updates on policy and procedure critical to claims process.

Perform other duties as assigned.

Duties Continued

Education Required

Bachelor's Degree in Business Administration or Healthcare Related FieldIn lieu of degree, equivalent education and/or experience may be considered.

Education Preferred

Experience


Required:
A minimum of 3-5 years of Managed Care, Medicaid, Medicare experience required.

A minimum of 3-5 experience in design and delivery (facilitating and coordinating) of training programs.

Skills

Required:
Strong understanding of learning principles and ability to demonstrate in classroom (or virtual classroom) situations.

Knowledge of CA regulatory guidelines, Medi-Cal guidelines, Medicare guidelines, NCQA requirements.

Skilled in group facilitation and managing effective discussion and dialogue to enhance the learning experience.

Strong organizational & analytical skills.

Ability to conduct effective and engaging presentations in a variety of delivery settings.

Ability to interpret technical data, processes, operating and maintenance instructions and procedure manuals.

Must be a strong team player willing to work toward achieving team goals. Must be flexible to meet the changing training needs.

Professional demeanor. Commitment to Team Culture.

Excellent written and verbal communications skills.

Proficient using Word, Excel, Power Point and Access. 

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Light

Additional Information

Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.  The range is subject to change.

L.A. Care offers a wide range of benefits including

  • Paid Time Off (PTO)
  • Tuition Reimbursement
  • Retirement Plans
  • Medical, Dental and Vision
  • Wellness Program
  • Volunteer Time Off (VTO)