The claims techs support regulatory duties including turnaround times, audits, and federal and state statutes. They support the front-line clerical staff who are responsible for incoming mail. This team sorts and forwards mail to multiple other areas which includes things like appeals, claims, applications, and legal documents.

POSITION PURPOSE: (Why does this position exist?)

Provide technical supervision and work direction to staff. Assumes the role of unit supervisor in the absence of unit supervisor in the absence of the supervisor. To organize and oversee the expedient and accurate adjudication of claims. To provide the direction, guidance and support necessary to bring about individual development in line with individual needs and department objectives. Serves as a project leader in the use, development, implementation and enhancement of systems, coordinates the activities of all affected areas.

ACCOUNTABILITIES: (Key roles, responsibilities & functions for this position)
(For supervisory position -- indicate positions/departments supervised)

Supervision: Assists in the selection, development and supervision of staff to ensure achievement of department objectives. Selects and motivates a competent workforce. Assumes the role of supervisor in the absence of the supervisor, this includes but is not limited to signing timecards, hiring and firing decisions, union issues and time off approval.

Technical Competence: Develop staff technical competence to ensure maximum production and quality standards. Designs and revises procedures as necessary to facilitate and make claims processing as efficient as possible. Prepares, conducts and analyzes both system and user audits to ensure new, promoting and existing employee’s technical competence, to heighten production and quality standards, improve and maximize system use. Provide follow up support through evaluation session with each staff member.

System Expert: Supports staff in identifying potential improvements in automated or manual processes. Provides expertise in training of system functionality including all modules of the claims system and DEC applications (auths, supplemental insurance, claims processing, on line benefits, membership systems, HCSS, etc.). Investigates claims problems and assists in their resolution. Conducts training of new examiners and remedial training of experienced examiners as needed. Performs benefit interpretation to define and facilitate development of procedures resulting from implementation or revision of claims processes. Maintains a current knowledge base and utilizes new training techniques and documentation. Ensures efficiency, eliminates redundancy, and utilizes other administrative resources for claims processing needs.

Data Interpretation: Ensures the quality to data collection through an audit process to meet the expected standards of the system users. Facilitates management assimilation of data by interpreting reports and highlighting trends. Determines quantity of claims required for the auditing of each examiner. Audits and authorizes payment of claims over examiner’s limits.

Support: Supports unit, departmental and divisional teams through participation and appropriate meetings and projects. Support includes coordination of all processes affected by the project to capture complete information for appropriate training documentation and implementation. Interacts with other supervisors and their personnel from other departments or organizations to resolve mutual problems. Participates in departmental planning and redesign.

Other Duties: Performs additional duties, attends meetings and assumes projects as assigned by supervisor, manager or director.

REQUIRED QUALIFICATIONS: (Minimum qualifications needed for this position)

Bachelor’s degree with at least two years of claims experience in the administration of insurance benefits, or Associate degree with two years of HealthPartners experience. Education requirement may be waived based on a minimum of four years of claims processing experience with demonstrated technical expertise.

Advanced analytical and problem solving ability.

Working knowledge of HealthPartners mainframe systems or equivalent experience with other claims systems.

Effective presentation, planning, oral and written communication skills with the ability to communicate at all levels of the organization and with external customer.

Detailed knowledge and understanding of the insurance industry including claims processing and customer service expectations.

Able to interpret and explain provider and member/employer contracts.

Must be highly flexible, able to handle and manage a high degree of change.

Able to work independently and as a team player.

Knowledgeable of total quality management concepts.

Able to identify individual training needs and provide appropriate instruction.

PREFERRED QUALIFICATIONS:

Bachelor’s degree in management, business administration, or an Associate degree with at least two years of HealthPartners claims processing experience.

Working knowledge of HealthPartners claims processing systems.

Thorough knowledge of HealthPartners member and provider contracts.

Working knowledge of reporting programs.

Previous project management experience.

Experience using desktop publishing software e.g., Microsoft Word, Excel, PowerPoint and familiarity with training equipment and materials.

DECISION-MAKING: (What rules or precedents limit the activities and authority of this position? What types of problems or decisions are referred to the supervisor?)

Authority to design and develop training program coursework, create policies and procedures and make logical decisions independently.

Is an independent contributor to cost effective processing for the department.

Function independently in the areas of auditing and provide feedback to staff.

Assists in hiring, firing, coaching and discipline of staff.

Approves time off requests.

Assist supervisor in the management of work flow, deadlines, and work projects.