[Remote] Operations Trainer (Remote)

Note: The job is a remote job and is open to candidates in USA. Evry Health is a next-generation health plan focused on simplifying healthcare for its members. The Remote Virtual Claims & Customer Service Trainer is responsible for designing and delivering training programs for contact-center and claims operations staff, ensuring they are equipped with the necessary skills and knowledge to excel in their roles. This position involves onboarding new hires, ongoing training, and developing training materials to enhance operational efficiency.

Responsibilities

• Deliver engaging, interactive training sessions via Teams platform for new hires and tenured staff covering product knowledge, soft skills, and systems navigation
• Lead structured onboarding programs covering Evry Health’s products, systems, workflows, policies, and member-centric service standards
• Design and facilitate live role-play scenarios that mirror real customer interactions, claims inquiries, and escalation situations
• Combine synchronous instructor-led sessions with asynchronous e-learning modules, job aids, and recorded content
• Administer knowledge checks, quizzes, and skills assessments to confirm learner readiness before live deployment
• Monitor staff performance; identify training gaps and deploy targeted interventions to address deficiencies quickly
• Collaborate with Operations leadership to craft clear, timely change communications that prepare agents for upcoming system or workflow transitions
• Train staff on end-to-end claims lifecycle, adjudication, issue identification and remediation, including testing outcomes, denial, adjustment, and dispute procedures
• Deliver training on Texas Insurance Code Chapter 1467, prompt-pay requirements, IDR processes, and CMS guidelines
• Provide foundational instruction on ICD-10, CPT, HCPCS, and modifier usage as it relates to claims review and provider disputes
• Train staff on internal and external dispute resolution processes, timelines, and documentation requirements
• Train agents on Evry Health’s call-handling protocols and quality expectations
• Coach staff on professional, empathetic communication
• Reinforce 1-business-day (member) and 2-business-day (provider) correspondence turnaround standards and documentation requirements
• Build staff confidence in identifying, documenting, and escalating complex or sensitive cases to supervisory and clinical teams
• Align training content with QA audit rubrics covering call quality, case accuracy, and documentation standards
• Develop and maintain SOPs, job aids, desk-top procedures, e-learning modules, and quick-reference guides for all operational workflows
• Build comprehensive knowledge assessments with scoring rubrics aligned to benefit program content and operational standards
• Promptly revise training materials in response to regulatory changes, system updates, or operational policy revisions
• Upload, organize, and track training completion records
• Generate training completion reports, assessment score summaries, and gap-analysis data for Operations leadership
• Partner with subject matter experts across Claims and Customer Service Operations to capture process knowledge, workflow nuances, and performance expectations, then translate that expertise into role-specific curriculum with the level of detail required for staff to accurately and confidently perform their job functions
• Review and restructure existing Desktop Procedures (DTPs) and current operational documentation, consolidating and reformatting content into a consistent, standardized format aligned with Operations’ style and readability requirements

Skills

• Bachelor's degree in Business, Healthcare Administration, Education, Communication, or a related field; or equivalent work experience
• 3–5 years of experience in health plan operations (claims and/or customer service); minimum 2-4 years in a training, coaching, or instructional role. Strong preference for background in operations and contact centers
• Working knowledge of claims adjudication, appeals/grievances, EOBs, ICD-10/CPT coding. Texas Insurance Code knowledge is a plus
• Demonstrated expertise in contact-center operations including call quality, and member/provider communication standards (both verbal and written)
• Proven ability to engage and manage remote audiences via Zoom, Microsoft Teams, or equivalent video-conferencing platforms
• Experience with Salesforce, Vonage, and/or comparable CRM, telephony, and health plan platforms
• Exceptional written and verbal communication skills; ability to translate complex regulatory and clinical content into plain-language training
• Strong project-management skills with the ability to manage multiple training cohorts, deadlines, and content-revision cycles simultaneously
• Certification in instructional design, adult learning (CPLP, ATD), or a related credential
• Experience with e-learning authoring tools such as Articulate 360, Rise, or Adobe Captivate
• Familiarity with CMS Star Ratings, NCQA, or URAC accreditation standards
• Prior experience supporting UAT, system rollouts, or technology implementation projects
• Background in employer-sponsored health plan administration/ Commercial health insurance
• Experience building and administering knowledge-check assessments with scoring rubrics

Benefits

• Fully remote; home office with reliable high-speed internet required.
• Evry Health-issued laptop, headset, and collaboration tools provided.

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