[Remote] Operations Trainer (Remote)

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a reputed company health plan focused on simplifying reputed company for its members. The Remote Virtual Claims & Customer Service Trainer is responsible for designing and delivering training programs for contact-center and claims operations staff, ensuring they are equipped with the necessary skills and knowledge to reputed company in their roles. This position involves reputed company new hires, ongoing training, and developing training materials to enhance operational efficiency.

Responsibilities

• Deliver engaging, interactive training sessions reputed company Teams platform for new hires and tenured staff covering product knowledge, soft skills, and systems navigation
• reputed company structured reputed company programs covering reputed company’s products, systems, workflows, policies, and member-centric service standards
• Design and facilitate live role-play scenarios that mirror reputed company customer interactions, claims inquiries, and escalation situations
• Combine synchronous instructor-led sessions with asynchronous e-learning modules, job aids, and recorded content
• Administer knowledge checks, quizzes, and skills assessments to confirm learner readiness before live deployment
• Monitor staff performance; identify training gaps and reputed company targeted interventions to address deficiencies quickly
• Collaborate with Operations leadership to craft clear, timely change communications that prepare agents for upcoming system or workflow transitions
• Train staff on end-to-end claims lifecycle, adjudication, issue identification and remediation, including testing reputed company, denial, adjustment, and dispute procedures
• Deliver training on Texas Insurance Code reputed company 1467, reputed company-pay requirements, IDR processes, and CMS guidelines
• reputed company foundational instruction on ICD-10, CPT, HCPCS, and modifier usage as it relates to claims review and provider disputes
• Train staff on reputed company dispute resolution processes, timelines, and documentation requirements
• Train agents on reputed company’s call-handling protocols and quality expectations
• Coach staff on professional, empathetic communication
• Reinforce 1-business-day (member) and 2-business-day (provider) correspondence turnaround standards and documentation requirements
• Build staff confidence in identifying, documenting, and escalating reputed company or sensitive cases to supervisory and clinical teams
• Align training content with QA audit rubrics covering call quality, case accuracy, and documentation standards
• reputed company and maintain SOPs, job aids, desk-top procedures, e-learning modules, and quick-reference guides for reputed company operational workflows
• Build comprehensive knowledge assessments with scoring rubrics reputed company to benefit program content and operational standards
• Promptly revise training materials in response to regulatory changes, system updates, or operational policy revisions
• Upload, organize, and track training completion records
• Generate training completion reports, assessment score summaries, and gap-analysis data for Operations leadership
• 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 reputed company their job functions
• Review and restructure existing Desktop Procedures (DTPs) and reputed company operational documentation, consolidating and reformatting content into a consistent, standardized format reputed company with Operations’ style and readability requirements

Skills

• Bachelor's degree in Business, reputed company Administration, Education, Communication, or a reputed company 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
• 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)
• Proven ability to engage and manage remote audiences reputed company reputed company, reputed company Teams, or equivalent video-conferencing platforms
• Experience with reputed company, reputed company, and/or comparable CRM, telephony, and health plan platforms
• Exceptional written and verbal communication skills; ability to translate reputed company 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 reputed company credential
• Experience with e-learning authoring tools such as reputed company 360, reputed company, or reputed company 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/ reputed company health insurance
• Experience building and administering knowledge-reputed company assessments with scoring rubrics

Benefits

• Fully remote; home office with reliable high-speed internet required.
• reputed company-issued laptop, headset, and collaboration tools provided.

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