Claims Team Lead II

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

📋 Description

• Directly oversee a team of typically 12–15 claims examiners and adjusters.

• Understand and adhere to client-specific guidelines.

• Monitor and manage the productivity targets of downline staff, ensuring financial and procedural accuracy standards are met.

• Collaborate on special projects including process documentation, training, quality audits, and client surge activities.

• Communicate with management to resolve issues and concerns, implementing preventive measures to ensure processing accuracy and quality.

• Assemble and delegate projects related to provider data, authorizations, enrollment, or other relevant information.

• Perform additional duties as assigned by leadership.

• Deliver an exceptional claims operation while meeting or exceeding service-level agreements and KPIs.

• Drive operational excellence and enhance competencies for effective delivery.

• Engage extensively with client organizations and various stakeholders.

⛳️ Requirements

• A minimum of 5 years of experience in healthcare claims processing (HRP).

• Strong understanding and capability to effectively lead a claims team.

• Excellent verbal and written communication skills.

• Proficiency in Microsoft applications, particularly Excel, is recommended.

• Knowledge of ICD-10, CPT, and HCPCS coding is advantageous.

• Familiarity with physician billing, hospital coding (ICD-10, HCPC, CPT-4), medical terminology, and authorization requirements.

• Eagerness to learn new skills.

• Ability to work collaboratively within a team.

• Strong work ethic.

• Capacity to adapt swiftly to a fast-paced environment.

• Self-motivated and quick to learn.

• Proven ability to work as a team player.

• Capability to mentor the team to achieve its maximum potential.

• Dependable with the ability to work independently.

• Candidates may need to undergo a pre-employment criminal background check.

🏝️ Benefits

• Remote work opportunities.

• Hybrid or fully remote work options available.

• Travel may be required based on company needs.

• Reasonable accommodations for individuals with disabilities.

• Equal opportunity employer dedicated to fostering workforce diversity.