Senior Claims Trainer and Technical Specialist

HealthPartners is hiring a Senior Claims Trainer and Technical Specialist. The Senior Claims Trainer and Technical Specialist will play a key support role for the Commercial Service Center by partnering with operational leaders, examiners, and technical teams. This individual will support system enhancements, training development, data collection, and audit readiness to ensure operational accuracy, compliance, and continuous improvement. The Claims Senior Trainer and Technical Specialist will be responsible for collecting and organizing data required for employer audits and Requests for Proposals (RFPs), ensuring information is accurate, timely, and well-documented. In addition, they may serve as the primary point of contact during audits and must be able to respond confidently and effectively to auditor inquiries in a high‑pressure environment. The individual will maintain and update the knowledge database, ensuring content remains current, accessible, and aligned with system and process changes.

In addition, the Claims Senior Trainer and Technical Specialist will support ad hoc reporting needs, assisting leadership with data pulls, summaries, and trend analysis as requested. The role will also act as an assistant for government-related audits impacting the Commercial Service Center, helping to gather documentation, respond to data requests, and support audit preparation activities. Overall, this position serves as a critical connector between operations, training, data, and compliance efforts within the Commercial Service Center.
 

Training and Resources Activities:

Provides expertise in training for new and existing employees of system functionality including all modules of the claims system and DEC applications. Formulate training sessions based on department needs including but not limited to: systems, products, compliance requirements and member and provider experience. 

Develop staff technical competence to ensure maximum production and quality standards. Design and revise procedures as necessary to facilitate claim processes are as efficient as possible. 

Train employees across employee hierarchy (front line to leadership) to assist in the development of knowledge, skills and abilities. Coaches and mentors to department trainers. 

In partnership with leadership, address performance issues with claim staff, providing input on development and training needs for employee specific scenarios.

Create and develop departmental and interdepartmental policies & procedures and resources to support Claims and other departments as needed. Analyze other department and corporate information for inclusion in department resources. 

System Support Activities

Develop and recommend potential system enhancements and modifications of Claim applications and other health plan systems. Assist with testing system enhancements and modifications of Claim applications and other health plan systems.

Work with the Claim Benefit team to coordinate Claim benefit set up for administered products. Audit benefit set-up within the claim system to ensure accurate adjudication of claim.

Assists Claim staff and other Riverview (HealthPartners) departments as the primary technical resource regarding questions/problems related to the use of Claim and Health plan system applications and their processes. 

Identify potential improvements in automated or manual processes; suggest changes to improve processes, update user documentation and operational procedures including enhancements in auto adjudication rates.

Works with Claims Leadership team to implement enhancements and manage change. 

Designs and revises procedures as necessary to facilitate and make claims processing as efficient as possible. 

Additional Accountabilities:

Actively participate in cross-functional initiatives, projects, and reoccurring inter-departmental meetings. Appling experience and expertise to ensure claims experience meets HealthPartners expectations. 

Participate in business continuity planning and implementation.

Actively participates in the preparations for regulatory audits, including universe and file submissions, documentation requirements and presentations to compliance regulators. 

Perform other duties and projects as assigned by supervisor, manager, or director.