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Lead Training Specialist, Grievance & Appeals
3 years ago

Summary of Position

Collaborate with the Director to develop and provide training and education programs that include onboarding of new non-
clinical G&A employees and continuing education for all non-clinical G&A staff.
Develop and maintain reference and resource materials.
Assist with creation and distribution of G&A policies and process documents.
Organize and implement cross-departmental training.
Support the G&A operations with business priorities and initiatives as needed.

Principal Accountabilities

Develop training programs in conjunction with the G&A management team to meet ongoing operational and
regulatory needs and achieve quality outcomes; deliver (in-person and virtual) G&A process and systems courses as
business needs dictate for new hire, upskilling, and refreshers.
Ensure that new hires have the tools to begin their positions successfully.
Meet with new hires regularly within their first 90 days of employment, and as requested by management thereafter,
to determine additional educational needs.
Develop/provide input in the development of targeted training courses for specific G&A business functionalities.
Determine new training opportunities to increase understanding of business processes.
Obtain and interpret feedback of results to determine if training was effective and to identify opportunities to improve
materials, coursework, and assessments.
Develop and maintain training materials, CMORE and OPPRAH repositories, operations manuals, and other reference
tools and resources to reflect regulatory, accreditation, and internal standards.
Work with stakeholders to create and enhance training material to ensure accuracy and that delivery reflects best
practices to support the overall current training requirements as well as changes that need to be incorporated.
Evaluate processes and resources to ensure they meet regulatory, accreditation, and internal standards.
Provide updates of new and revised resources and training material to G&A staff.
Maintain current knowledge of best practices, requirements, learning tools, courses, etc.
Maintain mastery level of understanding of all G&A workflows and seek opportunities for deeper knowledge.
Act as a backup for other G&A staff as needed; perform other duties as assigned by G&A leadership

Education, Training, Licenses, Certifications

Bachelor's Degree preferred

Relevant Work Experience, Knowledge, Skills, and Abilities

4 - 6+ years' relevant, professional work experience required
Proven experience in various types of training (hands-on, virtual, classroom) required
Proven ability to develop and deliver effective training materials, processes, and sessions required
Additional experience/specialized training may be considered in lieu of educational requirements required
Knowledge of adult learning theory required
Excellent communication skills (verbal, written, presentation, interpersonal/relationship building) required
Ability to interact professionally and effectively with all levels of staff required
Ability to convey complex information in a way that people understand required
Excellent organizational, decision-making, problem identification and resolution, and time management skills required
Knowledge of grievance and appeals processes required
Knowledge of NCQA regulations, state, and federal guidelines regarding the processing of member/provider
Correspondence preferred
Proficiency in MS Office applications (Word, Excel, PowerPoint, Outlook, Teams) required
Strong product knowledge required

Additional Information

  • Requisition ID: 1000000559








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