Claims Team Lead

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

📋 Description

• A process leader is responsible for guiding, monitoring, and managing a team of employees to reach their goals.

• Provides daily guidance and communication to staff to ensure that business objectives are met in an efficient and knowledgeable manner.

• Oversees the operational activities of claims examiners to guarantee that claims are processed accurately and in a timely fashion.

• Offers technical support, expert advice, and coaching to team members and clients.

• Identifies new opportunities to enhance operational effectiveness and customer satisfaction, and makes recommendations for improvements.

• Recognizes skill gaps and ensures that training is provided for the continuous development of staff.

• Responsible for managing team conflicts and addressing any personnel-related issues.

• Addresses complaints, DOI, appeals, etc. Ensures adherence to process reporting and is capable of drafting process documents, including SOPs, updating trackers, and maintaining issue logs.

• Possesses the ability to conduct quality audits for team processes.

• Capable of communicating with clients regarding process-related issues and managing client calls effectively.

⛳️ Requirements

• One to two years of certificate or degree from a college or technical school; or 2-5 years of related experience and/or training; or an equivalent combination of education and experience.

• Must have advanced product knowledge, a comprehensive understanding of insurance terminology and definitions, and a solid knowledge of company and department processes and procedures necessary to perform job responsibilities proficiently and professionally.

• Should possess knowledge of medical terminology and have the ability to read and interpret most medical records/notes, including ICD-9/10 and CPT/HCPC/CDT coding; familiarity with various medical claim forms, such as HCFA-1500 and UB04 forms; and a working knowledge of the Insurance Industry and/or Healthcare.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health benefits package.

• Opportunities for professional development and training.

• A supportive and collaborative work environment.

• Flexible working hours and potential for remote work options.