Claims Team Lead

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

📋 Description

• Supervise a team of 4–7 Claims Processors and Senior Claims Processors.

• Offer continual support, address inquiries, and assist staff with complex or escalated cases.

• Manage daily claims processing, including the review of medical invoices and ensuring payments are processed in alignment with guidelines and timelines.

• Address escalated issues and disputes involving members and providers.

• Train, mentor, and provide constructive feedback to new and junior team members.

• Monitor departmental performance and track KPIs in collaboration with Management.

• Execute process enhancements and liaise with various departments.

• Identify inefficiencies and propose automation, system improvements, or procedural modifications.

• Ensure accurate member records are maintained in the CRM system and perform periodic claims audits.

• Engage directly with members, managing queries and escalations in a professional, empathetic, and precise manner.

⛳️ Requirements

• Bachelor's degree or equivalent experience in a relevant field.

• 2–3 years of experience in healthcare, claims processing, or a similar domain.

• 1–2 years of leadership experience.

• Preferred experience in process improvement, team management, or case management.

• Familiarity with CRM systems, such as Salesforce, is advantageous.

• Strong leadership capabilities with the ability to manage and inspire a team.

• Advanced understanding of medical terminology, claims processing, and medical billing practices.

• Proficient in working both independently and collaboratively in a fast-paced team environment.

• Outstanding communication skills with a focus on customer service.

• High attention to detail, accuracy in documentation, and data entry.

• Critical thinking and problem-solving abilities, particularly in resolving escalated issues.

• Capacity to multitask and adapt to shifting priorities effectively.

• Knowledge of claims management software and medical billing procedures.

• Proficient in using Google Suite and CRM systems (Salesforce preferred).

🏝️ Benefits

• Competitive salary and comprehensive benefits package.

• Engaging and innovative work environment.

• Opportunities for professional advancement and development.

• Flexibility for remote work.