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PSA Claims Team Lead at PacificSource in Springfield, Oregon

Posted in Other 30+ days ago.

Job Description:

Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care!

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

Position Overview: Supervise and provide guidance to the Claims and Production Support Teams regarding company policies, procedures, workflow and resolving systemic and operational issues. Participate in the hiring of new team members, training, coaching, counseling, and evaluating performance. Monitor, evaluate, and report service standards. Demonstrate effective leadership by coaching to improve individual performance, support teamwork, manage change and encourage innovation, build collaborative relationships, encourage involvement and initiative, and develop increased vision and commitment to goals of others.

Essential Responsibilities:
  • Provide supervision, coaching, performance evaluation, and leadership to assigned staff.
  • Evaluate performance of team members by performing monthly audits and quality review. Analyze results of performance reports for each team member to determine training needs related to individual performance and department goals. Assure production quality meets department and company standards.
  • Conduct and/or assist in training and orientation of new hires. Work with management staff to develop programs to assure ongoing training and coaching for new and current staff.
  • Interact with vendors regarding our business needs/production issues.
  • Ensure staff has sufficient training.
  • Attend vendor conferences as necessary.
  • Monitor daily and weekly claims stats in order to provide appropriate staffing and accuracy.
  • Oversee and assist with review of claims issues presented by Customer Service
  • Assist with claims payment audits.
  • Develop testing and rollout plans with upgrades.
  • Act as a liaison with all PSA departments to coordinate optimal provision of service and information.
  • Participate on various interoffice committees as required or needed. Document and report any pertinent communications back to the team or department.
  • Prepares written correspondence using system generated reports and word-processing system. Prepares reports using spreadsheet software.
  • Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
  • Communicate changes in PSA business processes and procedures to internal and external customers accurately and timely.
  • Assist with hiring, staff development, coaching, performance reviews, corrective actions, and termination of employees. Provide feedback, including regular one-on-ones and performance evaluations, for direct reports.
  • Assist with process improvement and work with other departments to improve interdepartmental processes. Utilize lean methodologies for continuous improvement. Utilize visual boards and daily huddles to monitor key performance indicators and identify improvement opportunities.
  • Actively participate as a key team member in department meetings.

Supporting Responsibilities:
  • Coordinate business activities by maintaining collaborative partnerships with key departments.
  • Maintain access permissions to all departmental specific software platforms.
  • Administer enhancements (field changes) to department specific software platforms.
  • Meet department and company performance and attendance expectations.
  • Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
  • Perform other duties as assigned.

Work Experience: Five years benefit plan system experience, preferably with specific FSA, HRA, and COBRA experience.

Education, Certificates, Licenses: BS/BA Degree preferred or equivalent work experience. High School diploma or GED required.

Knowledge: Advanced computer skills, Database management and configuration, ability to type using a standard keyboard and operate a 10-key pad accurately. Ability to work under time pressure and deal with complex technical issues and difficult situations that require significant research. Ability to clearly communicate with co-workers and take proactive and responsive action to ensure quality service. Ability to read and interpret health benefit plan document language.

  • Building Trust
  • Building a Successful Team
  • Aligning Performance for Success
  • Building Customer Loyalty
  • Building Strategic Work Relationships
  • Continuous Improvement
  • Decision Making
  • Facilitating Change
  • Leveraging Diversity
  • Driving for Results

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately less than 10% of the time.

Our Values
  • We are committed to doing the right thing.
  • We are one team working toward a common goal.
  • We are each responsible for customer service.
  • We practice open communication at all levels of the company to foster individual, team and company growth.
  • We actively participate in efforts to improve our many communities-internally and externally.
  • We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.