SME-Learning & Development

**Job Summary** Serve as a subject matter expert in learning and development for claims adjudication and health privacy regulation within payer and provider operations designing and delivering targeted hybrid learning experiences for night shift teams that enhance accuracy compliance and service quality while supporting the company mission to improve healthcare outcomes. **Responsibilities** * Design and deliver structured learning programs focused on claims adjudication workflows that help operational teams improve processing accuracy and cycle times in payer and provider environments. * Develop clear learning content on health privacy rules and related industry guidelines that supports consistent compliance in daily claims handling activities. * Conduct detailed training needs analysis with operations stakeholders to identify skill gaps in claims adjudication and translate them into focused learning objectives. * Create engaging digital and classroom ready learning assets tailored for hybrid work conditions so that night shift learners can access knowledge effectively. * Coordinate and facilitate interactive virtual sessions for night shift staff that encourage practical application of provider and payer concepts in real case scenarios. * Evaluate learner performance through assessments and scenario based exercises that reveal strengths and development areas in claims adjudication and health privacy understanding. * Track and analyze training effectiveness metrics such as error reduction rework rates and first pass resolution to demonstrate the impact of learning programs on business outcomes. * Partner with operations quality and compliance teams to keep learning content updated with current payer policies provider contracts and regulatory expectations. * Maintain detailed documentation of learning materials attendance records and evaluation results to support internal and external audits. * Provide targeted coaching and floor support during early adoption phases after training so that learners can confidently apply new skills on live claims. * Align learning plans with career development pathways for operations staff to support long term capability building in claims and health privacy disciplines. * Collaborate with knowledge management teams to convert frequently asked questions and recurring issues into concise learning resources for continuous reference. * Contribute to a culture of continuous improvement by gathering learner feedback and using it to refine learning design methods and delivery practices. **Qualifications** * Bring practical experience working in claims adjudication processes with clear understanding of end to end claim life cycle and common exception scenarios. * Demonstrate applied knowledge of health privacy administrative requirements and their implications on claim data handling and communication. * Offer hands on exposure to payer business rules benefit designs and authorization requirements that influence adjudication decisions. * Apply working knowledge of provider contracts reimbursement methodologies and coding standards as they relate to claim evaluation. * Utilize prior experience supporting operations or training functions for night shift or hybrid teams with sensitivity to schedule and engagement challenges. * Use strong communication and facilitation skills to explain complex payer and provider concepts in simple terms for diverse learner groups. * Employ basic data analysis skills to interpret performance reports and align learning interventions with measurable business needs.