Claims Team Lead
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Job Description
Claims Team Lead managing 12–15 examiners and claims operations for HealthEdge’s AI-powered health insurance infrastructure. Driving accuracy, KPIs, service levels, training, and operational excellence.
Responsibilities:
- Directly manage a staff of typically 12–15 associates
- Know and meet client-specified guidelines
- Monitor and manage downline staff productivity targets and financial and procedural accuracy standards
- Collaborate on manager-assigned special projects, including process documentation, training, quality audits, and surge activity support
- Maintain communication with management to address issues, concerns, and preventive measures ensuring processing accuracy and quality
- Assemble and assign projects involving provider data, authorizations, enrollment, or other information
- Deliver a high-quality claims operation while meeting or exceeding service level agreements and KPIs
- Drive operational excellence and build competencies for delivery
- Perform other duties assigned by leadership
Requirements:
- 5+ years healthcare claims processing experience
- Solid understanding and ability to effectively lead a claims team
- Good verbal and written communication skills
- Microsoft application experience, especially Excel suggested
- ICD-10, CPT, and HCPCS coding is a plus
- Knowledge of physician billing and hospital coding (ICD-10, HCPC, CPT-4)
- Knowledge of medical terminology and authorization requirements
- Willingness to learn new skills
- Team collaboration
- Strong work ethic
- Ability to adapt quickly to a fast-paced environment
- Self-starter and quick learner
- Ability to collaborate as a team player
- Ability to coach the team to reach its full potential
- Dependability and ability to work independently
- May be required to undergo a pre-employment criminal background check
Benefits:
- Remote work environment
- Work across multiple time zones
- May require travel dependent on company needs
- Reasonable accommodations for individuals with disabilities
- Equal opportunity and workforce diversity commitment
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