Job Summary
Join our team as a Subject Matter Expert in Claims HC where you will leverage your expertise in Facets Claims and Claims Adjudication to optimize our claims processing systems. With a focus on Dental and Commercial Claims you will play a pivotal role in enhancing operational efficiency and ensuring compliance with industry standards. This office-based role offers the opportunity to work in a dynamic environment contributing to impactful projects that benefit both the company and society.
Responsibilities
Lead the analysis and optimization of claims processing workflows to enhance efficiency and accuracy.Oversee the implementation of Facets Claims and Claims Adjudication systems to ensure seamless integration and functionality.Provide expert guidance on Dental and Commercial Claims processes to ensure compliance with industry standards.Collaborate with cross-functional teams to identify and resolve system issues improving overall operational performance.Develop and maintain documentation for claims processing procedures to support training and knowledge sharing.Monitor and evaluate system performance recommending improvements to enhance service delivery.Conduct regular audits of claims processes to ensure adherence to regulatory requirements and company policies.Facilitate training sessions for team members to enhance their understanding of claims systems and processes.Analyze data trends to identify opportunities for process improvements and cost savings.Support the development of new claims processing initiatives to drive innovation and efficiency.Communicate effectively with stakeholders to provide updates on project progress and system enhancements.Ensure that all claims processing activities align with the companys strategic goals and objectives.Contribute to the development of best practices for claims management to support continuous improvement. QualificationsDemonstrate proficiency in Facets Claims and Claims Adjudication with a strong understanding of system functionalities.Possess in-depth knowledge of Dental and Commercial Claims processes and industry standards.Exhibit excellent analytical skills to identify and resolve complex system issues.Show strong communication skills in English both written and verbal to effectively collaborate with team members.Display a proactive approach to problem-solving and process improvement.Have a minimum of 5 years of experience in claims processing with a focus on Dental and Commercial Claims.Be able to work independently and manage multiple tasks in a fast-paced environment.
Certifications Required
Certified Professional Coder (CPC) or equivalent certification in claims processing.
