Job Summary

The TL-Claims HC role requires a seasoned professional with 6 to 8 years of experience in claims management specifically focusing on Facets - Claims and Claims Adjudication. The candidate will work from the office during night shifts handling dental and commercial claims efficiently. Proficiency in English is essential for effective communication.

Responsibilities

Oversee the claims adjudication process to ensure accuracy and compliance with company standards.
Provide expert guidance on Facets
Claims system to streamline operations and enhance productivity.
Manage dental and commercial claims with precision to minimize errors and optimize claim processing time.
Collaborate with cross-functional teams to improve claims handling procedures and customer satisfaction.
Analyze claims data to identify trends and implement strategies for process improvement.
Ensure all claims are processed in accordance with regulatory requirements and company policies.
Develop training materials and conduct workshops to enhance team skills in claims management.
Monitor claims workflow and adjust resources to meet operational demands effectively.
Facilitate communication between stakeholders to resolve complex claims issues promptly.
Utilize advanced analytical skills to forecast claims trends and prepare reports for management.
Implement best practices in claims adjudication to maintain high standards of service delivery.
Support the development of new claims handling protocols to adapt to changing industry standards.
Drive initiatives to enhance the efficiency of claims processing through innovative solutions.

Qualifications

Demonstrate proficiency in Facets
Claims system and claims adjudication processes.
Possess in-depth knowledge of dental and commercial claims management.
Exhibit strong analytical skills to interpret claims data and drive improvements.
Show excellent communication skills in English to liaise with stakeholders effectively.
Have a proven track record of managing claims operations in a fast-paced environment.
Display ability to work night shifts and adapt to office-based work model.
Bring experience in developing training programs for claims management teams.

Certifications Required

Certified Professional in Healthcare Quality (CPHQ) Facets Claims Certification