Claims Examiner Team Leader
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Job Description
Claims Examiner Team Leader responsible for supervising claims processing teams and ensuring compliance in a remote setting. Focused on performance metrics and quality standards as part of Imagenet's healthcare operations.
Responsibilities:
- Responsible for leading and managing a team of claims examiners
- Ensure accurate, compliant, and timely processing of medical claims
- Serve as a critical bridge between frontline operations and leadership
- Drive performance against SLAs, quality standards, and productivity targets
- Accountability for team performance, coaching and development, and process improvement
- Ensure adherence to Medicare regulations and CMS guidelines
- Oversee day-to-day medical claims processing
- Monitor and manage service level agreements (SLAs), turnaround times, and production
- Apply deep working knowledge of CMS regulations, Medicare auditing standards, and payer guidelines
- Review claims and audit results to identify trends and training opportunities
- Analyze and manage key performance indicators including quality scores, error rates, productivity, and attendance
- Prepare and present operational and business reviews
- Identify operational risks, performance gaps, and improvement opportunities
Requirements:
- Min. 5 years of experience processing easy, moderate, and complex medical claims
- 2+ years in a leadership role within claims or healthcare operations
- Strong experience with Medicare and Medi-Cal claims, including a working knowledge of CMS guidelines and regulatory requirements
- Prior quality assurance and training experience with demonstrated ability to identify trends
- Previous experience leading, coaching, or mentoring teams in a claims or healthcare operations environment
- Strong analytical skills with the ability to interpret performance data and KPIs
- Excellent communication, organizational, and decision-making skills
- High attention to detail and commitment to accuracy, compliance, and operational excellence
Benefits:
- Remote work offered
- Equipment provided
- Paid training to set you up for success
- Comprehensive benefits: Medical, Dental, Vision, Life, HSA, 401(k)
- Paid Time Off (PTO)
- 7 paid holidays
- A supportive team and a company that values internal growth
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