Medical Claims Auditing and Training Supervisor

Company Overview:

ASR Health Benefits, based in Grand Rapids, MI, is a fast-growing third-party administrator of health plans, including medical, dental, vision, short-term disability, Section 125 plans, and consumer-directed health plans. We administer these health plans through dedicated client service teams, consisting of staff members from each department at ASR who work together to meet our clients’ needs.

Position Summary:

The Claims Integrity & Training Supervisor will supervise the auditing team and oversee department training. The position collaborates closely with their peer management team to identify learning gaps and opportunities, facilitate staff development, and ensure employees are trained to meet quality and productivity expectations before being assigned to a Unit.

Training will include both classroom-style sessions and individual one-on-one training. The Trainer must be comfortable using technology, current resources, and creating training materials to support remote training as needed. This position requires flexibility to train onsite in the office and remotely based on operational demands.

Key Responsibilities:

Training

• Design and conduct training for all Operations Teams.
• Develop, design, and implement training curriculum.
• Analyze training needs by reviewing audit results, provider appeals, and updated processes for trends.
• Provide monthly refresher training to the Claims Department.
• Prepare, update, and manage training materials, including syllabus and performance tracking.
• Prepare and forward a weekly leadership review document outlining training topics, quality, and production for each trainee.
• Update and manage the Claims Department audit log and distribute finalized audit metrics to leadership monthly.
• Provide one-on-one training as needed.
• Respond to analyst inquiries via the “ClaimsQuestion” Outlook mailbox.
• Collaborate with Stop Loss Specialists, Claims Auditors, Leaders, analysts, and other departments to ensure staff is trained in accordance with:
• internal policies and procedures
• applicable regulatory requirements
• accreditation standards

Leadership and Team Management

• Lead audit team activities and report results at department and individual levels.
• Provide technical guidance and directions to audit staff.
• Evaluate professional skills and set performance goals for team members.
• Monitor individual performance to ensure quality and productivity standards are met.
• Provide and document monthly feedback to team members via 1:1 meeting.
• Lead in accordance with ASR employee handbook.
• Develop and implement professional development plans.
• Assist in employee performance evaluations, promotions, retention, and termination activities.
• Participate in hiring and onboarding new employees.
• Monitor attendance and address Human Resource concerns.
• Lead by example and promote a positive, high-morale team environment.
• Oversee Claims Vendor production and outcomes.
• Facilitate weekly audit dispute review meetings.
• Other duties as assigned.

Preferred Skills and Qualifications:

• Strong critical thinking skills with the ability to exercise independent judgment.
• Ability to problem-solve effectively.
• Positive attitude, takes initiative, and works well independently and in a team environment.
• Strong ability to develop, design, and implement training curriculum.
• Ability to identify and adapt to different learning styles.
• Excellent verbal, written, and customer service skills.
• Proven claims processing experience.
• Ability to multitask, meet deadlines, and maintain strong organization.
• Commitment to continuous learning within the healthcare arena.
• Proficiency in Microsoft Word, Excel, and PowerPoint.
• Agreement that your likeness (e.g., name, image, voice, and/or video) may be used in internal and external materials with customers or prospective customers.

Preferred Experience:

• Knowledge and recent experience in ASR’s medical claims processing system preferred.
• VBA experience is preferred.
• Training experience is a plus.
• Interest in or experience leading others within the workplace.
• Strong interpersonal skills to motivate, guide, and collaborate with others.
• Excellent oral and written communication skills with the ability to organize and prioritize.
• Detailed in documentation and reporting.
• Coding Certificate is a plus.
• Experience in other coverage types (dental, vision, etc.) is a plus.

Required Education:

• Minimum of 2+ years of medical claims processing experience.
• High school diploma required.
• College or vocational education is desirable.

Work Environment:

This position follows a remote work structure, allowing employees to work from home, based on specific tasks or personal work preferences. There may be times when working in the office will be required.

Essential Functions:

Confidentiality: This position involves access to protected health information (PHI) and other sensitive data. Employees are expected to maintain strict confidentiality in accordance with HIPAA, company privacy policies, and all applicable federal and state regulations.

Pay: $56,300.00 - $67,900.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Retirement plan

Application Question(s):

• Do you have experience designing and/or conducting training programs?
• Do you have direct experience in processing medical claims?
• Do you have direct experience with the software platform VBA? (Virtual Benefits Administrator)

Work Location: Remote