Customer Solution Center Appeals and Grievances Training Development Specialist III

Job Summary

The Customer Solution Center (CSC) Appeals and Grievances (A&G) Training Development Specialist III plays a key role in enhancing employee skills, knowledge, and performance by designing, developing, and facilitating high-impact learning programs.

The Specialist III designs and conducts training programs using established regulatory and departmental guidelines. This position focuses on building engaging and effective learning experiences through instructional design, content development, and live facilitation.

Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.

Duties

Responsible for providing ongoing training on the core processing system, Appeals and Grievance (A&G) processing procedures, training regulatory changes that affect established procedures. 

Provide ongoing training on the core processing system, A&G processing procedures, training regulatory changes which will affect established procedures, working with the quality team on quality and performance guidelines, creating and maintaining departmental policy and procedures.

Evaluate initial training and ongoing learning opportunities to achieve consistency, efficiency, and productivity among the staff.

Work together with cross-functional teams to translate technical or complex content into accessible and engaging learning solutions.  Work with the quality team on quality and performance guidelines, in creating and maintaining departmental policy and procedures.

Develop storyboards, scripts, and prototypes for digital and blended learning solutions.  Use eLearning authoring tools (e.g., Articulate Storyline, Adobe Captivate, Rise 360) and Learning Management Systems (LMS) to deliver and manage content.

Design, develop, and deliver engaging learning content using instructional design best practices for in-person, virtual, and hybrid formats.  Evaluate initial training and ongoing learning opportunities to achieve consistency, efficiency, and productivity among the staff.

Duties Continued

Facilitate CSC A&G specific training sessions, workshops, and programs that support employee development, onboarding, leadership, and technical skill-building.  Maintain documentation, including database/system updates, training agendas, sign-in sheets, etc. to demonstrate trainee compliance with department requirements.

Assess training effectiveness and learner performance using feedback, analytics, and learning assessments; iterate to improve content quality and outcomes.  Identifies gaps in knowledge, skills and abilities, assess and recommend training/education measures to resolve issues and enhance staff performance.  Propose program modifications to enhance performance and positively influence member satisfaction survey results.

Create and manage the A&G courses for the Learning Management System (LMS), ensuring content is current, accessible, and engaging. Maintain A&G specific training documentation, including database/system updates, training agendas, sign-in sheets, etc. to demonstrate trainee compliance with department requirements. Conduct assessments after A&G specific training to measure, record, and report feedback on training material and sessions.

Applies subject expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the project’s/program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed.

Review and recommends updates on policy and procedure critical to claims process.

Stay current on trends in adult learning theory, instructional design, and facilitation techniques.

Perform other duties as assigned.

Education Required

Education Preferred

Experience

Required:

At least 4 years of experience in adult learning, design and delivery of training programs. 

Experience with both digital and instructor-led learning solutions.

Proven experience in instructional design and training facilitation.

Experience in Managed Care, Medicaid, Medicare experience.

Experience working in an Agile or fast-paced environment.

Preferred:

Experience with Appeals and/or Grievances.

Experience measuring learning effectiveness and applying data to improve content.

Skills

Proficient trainer skills. Knowledge of corporate training, onboarding, or compliance programs. Knowledge of adult learning principles and curriculum design methodologies. Ability and passionate about fostering a culture of continuous learning and growth.

Extensive knowledge and ability in curriculum development. Knowledge and understanding of accessibility and universal design principles. Proficiency in eLearning authoring tools and graphic/multimedia tools (e.g., Adobe Creative Suite, Camtasia). Proficiency in e-learning development tools (e.g., Articulate Storyline, Camtasia, Canva) and LMS platforms.

Strong platform skills with the ability to engage and inspire learners in both virtual and in-person environments.

Excellent attention to detail, organization, and time management. Ability to manage multiple projects with shifting priorities.

Excellent writing, visual design, and storytelling skills. Excellent written, verbal, and interpersonal communication skills.

Excellent team works still with the ability to achieve team goals.

Ability to conduct effective and engaging presentations in a variety of delivery settings.

Ability to interpret technical data, processes, operating and maintenance instructions and procedure manuals.

Strong analytical skills.

Must be flexible to meet the changing training needs.

Excellent Word, Excel, Power Point and Access skills.

Preferred:

Strong project management skills with the ability to manage multiple training initiatives simultaneously.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information

Required to work after hours, weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in critical situations and work on-call.

Required on handling various caseloads and flexibility to adapt to changing priorities which may include but not limited to redistributed work assignments, team projects, and other priorities as assigned.

The ideal candidate is a dynamic trainer and curriculum developer who is passionate about fostering a culture of continuous learning and growth across the organization