Operations Trainer

Role Overview

• Deliver engaging, interactive training sessions via Teams platform for new hires and tenured staff covering product knowledge, soft skills, and systems navigation.
• Lead structured onboarding programs covering Evry Health’s products, systems, workflows, policies, and member-centric service standards.
• Design and facilitate live role-play scenarios that mirror real 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 deploy 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 outcomes, denial, adjustment, and dispute procedures.
• Deliver training on Texas Insurance Code Chapter 1467, prompt-pay requirements, IDR processes, and CMS guidelines.
• Provide foundational instruction on ICD-10, CPT, HCPCS, and modifier usage as it relates to claims review and provider disputes.
• Train agents on Evry Health’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 complex or sensitive cases to supervisory and clinical teams.
• Align training content with QA audit rubrics covering call quality, case accuracy, and documentation standards.
• Develop and maintain SOPs, job aids, desk-top procedures, e-learning modules, and quick-reference guides for all operational workflows.
• Build comprehensive knowledge assessments with scoring rubrics aligned 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.

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.
• 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 via Zoom, Microsoft Teams, or equivalent video-conferencing platforms.
• 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 (preferred).
• Experience with e-learning authoring tools such as Articulate 360, Rise, or Adobe Captivate (preferred).
• Familiarity with CMS Star Ratings, NCQA, or URAC accreditation standards (preferred).

Benefits

• Evry Health-issued laptop, headset, and collaboration tools provided