Claims Production Team Lead
Company: Cambia Health
Location: Yakima
Posted on: January 15, 2022
|
|
|
Job Description:
Primary Job Purpose
Remote within: OR, WA, ID and UT
At Cambia, our members need us more than ever, and to continue
serving them, we need to be vaccinated. Following federal mandate,
all Cambia Health Solutions employees, including 100% remote
workers, need to be fully vaccinated for COVID-19 by 1/1/22.
The Member Services Lead assists their supervisor in accomplishing
and supporting department and corporate strategic objectives by
organizing, monitoring, training and scheduling staff activities to
meet or exceed performance standards and service level goals. They
keep lines of communication open between management and staff, and
establish excellent rapport with all levels of staff and external
customers. The Lead may also function as a technical resource for
the department or, alternatively, may focus on training and
coaching employees, depending on needs of the particular
department. This position leads employees but has no reporting
subordinates.
General Functions and Outcomes
Handle difficult or escalated calls, claims or inquiries from
members, providers, employer groups, agents, member representatives
and internal customers with timely follow through.
Thoroughly research inquiries, complaints and requests for
adjustments, take appropriate steps to correct any errors.
Communicate decision with supervisor, staff, and customer. Share
information gathered; provide helpful reminders to staff to ensure
correct procedures are followed consistently.
Answer questions for team members and provide coaching and
assistance, as needed. May provide training to team members as well
as staff from other departments in an effort to promote internal
customer service.
Ensure superior customer service to both internal and external
clients and be accountable by following through on commitments.
Assist in monitoring and distributing staff workload and assist
with workload as necessary to meet service requirements.
Assist supervisor in improving performance by participating in
meetings, identifying training needs and making recommendations for
on-going training, orienting new employees, and reinforcing
learning through coaching. Provide feedback and coaching to
employees on routine performance issues, as directed by
supervisor.
Assist supervisor in establishing department goals by gathering
service information from reports covering status of work,
inventories, turnaround, attendance, timeliness, quality and
quantity performance measures of employees. Assist in identifying
and evaluating trends, developing a course of action and evaluating
outcomes.
Assist in the maintenance of reference manuals and procedure
guidelines. May assist in generating user documentation of
processes, policies, and procedures in response to business changes
and ensure staff is updated on any changes or modifications.
Troubleshoot system malfunctions and coordinate with IT as
necessary. Identify business and technical problems, trends or
irregularities and recommend appropriate solutions.
Participate in system enhancements, development, coordination,
testing and implementation.
Assist in interviewing applicants and may provide input to
supervisor regarding performance of employees.
Back up supervisor as needed.
Comply with MTM and Consortium standards as they relate to the
employee's responsibility to meet BlueCross BlueShield Association
(BCBSA) standards and corporate goals.
Willing to work overtime and on weekends as needed.
Represent department as a member of company-wide teams and work
groups.
Minimum Requirements
Excellent verbal and written communication skills with the ability
to interpret and communicate information with tact, diplomacy,
patience and professionalism.
Demonstrated analytical ability in identifying problems, developing
solutions, and implementing a course of action.
Demonstrated PC Skills including Word, Excel and Outlook and other
corporate software program or comparable software.
Ability to prioritize and delegate work.
Ability to serve as a resource to correct technical and/or
system(s) problems.
Ability to recognize inappropriate or invalid claims or inquiries
and research, resolve and communicate resolution to concerned
parties.
Ability to listen and communicate appropriately with provider
community, members, employer groups, agents, member
representatives, and coworkers in a manner that promotes positive,
professional interaction while maintaining confidentiality.
Normally to be proficient in the competencies listed above
The Member Services LD would have a High School diploma or GED and
minimum five years progressive work experience in customer service,
claims processing, membership billing or enrollment, as applicable
to position, or equivalent combination of education and experience.
Healthcare experience preferred.
Work Environment
Sitting and working at a PC for extended periods of time.
This position includes 401(k), healthcare, paid time off, paid
holidays, and more. For more information, please visit
www.cambiahealth.com/careers/total-rewards.
We are an Equal Opportunity and Affirmative Action employer
dedicated to workforce diversity and a drug and tobacco-free
workplace. All qualified applicants will receive consideration for
employment without regard to race, color, national origin,
religion, age, sex, sexual orientation, gender identity,
disability, protected veteran status or any other status protected
by law. A background check is required.
If you need accommodation for any part of the application process
because of a medical condition or disability, please email
CambiaCareers@cambiahealth.com. Information about how Cambia Health
Solutions collects, uses, and discloses information is available in
our Privacy Policy.
Keywords: Cambia Health, Yakima , Claims Production Team Lead, Professions , Yakima, Washington
|
Click
here to apply!
|
