SME-Learning & Development

Job Summary

This hybrid role as a subject matter expert in learning and development focuses on creating and delivering training solutions for claims adjudication and health care compliance within provider and payer environments. The position supports night shift operations enabling global coverage while ensuring accurate claims handling regulatory alignment and continuous capability building across multiple functional teams.

Responsibilities

• Design comprehensive training programs that build strong capability in claims adjudication processes for provider and payer operations while aligning with current business objectives and quality standards.
• Develop detailed learning content that simplifies complex health care claim rules and workflows so that new and existing team members can perform adjudication tasks with high accuracy and consistency.
• Deliver engaging virtual and classroom training sessions during night shift hours to support hybrid team members and ensure consistent knowledge transfer across locations.
• Conduct targeted training needs analysis by collaborating with operations and quality teams to identify skill gaps in claims adjudication and prioritize high impact learning interventions.
• Monitor learner performance data and quality audit outcomes to refine course materials and ensure that training directly improves claim resolution accuracy and turnaround time.
• Ensure that all learning content reflects current health care regulations and privacy requirements related to HIPAA so that team members handle sensitive information responsibly.
• Create practical simulations and case based exercises that mirror real life provider and payer claim scenarios to help learners build confidence and decision making skills.
• Provide ongoing floor support during production hours by answering process queries and clarifying adjudication rules so that associates can resolve complex claims efficiently.
• Collaborate with process experts and compliance teams to update training materials whenever there are changes in benefit designs coding standards or regulatory guidance.
• Track training effectiveness through feedback surveys assessments and quality metrics and present insights that show how learning programs support business performance and member satisfaction.
• Maintain detailed training records and documentation that support internal audits and demonstrate adherence to organizational learning standards and regulatory expectations.
• Coordinate with workforce management and team supervisors to schedule training sessions that minimize business disruption while meeting the needs of night shift hybrid associates.
• Support the adoption of digital learning tools and knowledge repositories so that team members can access updated claims adjudication and HIPAA guidance on demand.

Qualifications

• Apply strong knowledge of health care claims adjudication rules benefit structures and payment policies to design technically accurate learning content for provider and payer processes.
• Use hands on experience with provider and payer workflows to explain real world scenarios and guide learners in applying policy rules to complex claim situations.
• Apply working knowledge of HIPAA requirements and data privacy expectations to embed compliance guidelines into every stage of the learning and support process.
• Utilize prior operations or quality experience within claims environments to connect training topics with performance outcomes such as first pass resolution and reduced rework.
• Demonstrate proficiency with common office productivity tools and learning platforms to create clear presentations job aids and reference guides for hybrid teams.
• Communicate clearly and inclusively with diverse audiences across global locations while adapting explanations to suit different experience levels and learning styles.
• Show readiness to work permanent night shifts in a hybrid work model while maintaining high levels of responsiveness reliability and collaboration with onshore and offshore partners.