Claims Examiner Team Leader

This is a fully remote position, open to applicants in Florida.

📋 Description

• Lead and manage a team of claims examiners.

• Ensure the processing of medical claims is accurate, compliant, and timely.

• Act as a vital link between frontline operations and leadership.

• Drive performance in accordance with SLAs, quality standards, and productivity goals.

• Responsible for team performance, coaching, development, and process enhancement.

• Guarantee compliance with Medicare regulations and CMS guidelines.

• Supervise day-to-day processing of medical claims.

• Oversee and manage service level agreements (SLAs), turnaround times, and production metrics.

• Utilize extensive knowledge of CMS regulations, Medicare auditing standards, and payer guidelines.

• Review claims and audit outcomes to pinpoint trends and training needs.

• Analyze and manage key performance indicators such as quality scores, error rates, productivity, and attendance.

• Prepare and deliver operational and business reviews.

• Identify operational risks, performance deficiencies, and opportunities for improvement.

⛳️ Requirements

• Minimum of 5 years of experience in processing easy, moderate, and complex medical claims.

• At least 2 years in a leadership capacity within claims or healthcare operations.

• Strong expertise with Medicare and Medi-Cal claims, alongside a solid understanding of CMS guidelines and regulatory requirements.

• Prior experience in quality assurance and training with a proven ability to identify trends.

• Previous leadership, coaching, or mentoring experience within a claims or healthcare operations setting.

• Strong analytical abilities to interpret performance data and KPIs effectively.

• Excellent communication, organizational, and decision-making skills.

• High attention to detail and a commitment to accuracy, compliance, and operational excellence.

🏝️ Benefits

• Opportunity for remote work.

• Equipment provided for your role.

• Paid training designed to ensure your success.

• Comprehensive benefits package including Medical, Dental, Vision, Life, HSA, and 401(k).

• Paid Time Off (PTO) included.

• 7 paid holidays throughout the year.

• A supportive team environment and a company that prioritizes internal growth.