Healthcare Claims Team Lead

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

📋 Description

• Oversee the complete client implementation process, from initial discovery to go-live and stabilization.

• Convert client needs into operational workflows, standard operating procedures (SOPs), and staffing models.

• Create and implement comprehensive implementation plans that include timelines and key milestones.

• Detect risks early and actively develop mitigation strategies.

• Collaborate with Training, Quality Assurance, IT, and Workforce Management teams to guarantee readiness across all workstreams.

• Manage system configuration, user acceptance testing (UAT), and access provisioning in conjunction with IT and client teams.

• Ensure that all systems, tools, and environments are thoroughly tested and ready for production before going live.

• Assist in the creation of process documentation, job aids, and knowledge base materials.

• Validate workflows for claims processing, including managing escalation paths and exception handling.

• Make certain that processes are scalable, efficient, and meet client expectations.

• Fulfill standard Team Lead responsibilities, which include team oversight, performance management, and reporting.

• Take charge of Quality Assurance and Training activities during the implementation phase.

• Provide practical support in constructing, testing, and executing processes.

⛳️ Requirements

• A minimum of 5 years of experience in processing easy, moderate, and complex medical claims (preferably on the payer side).

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

• Demonstrated experience in implementations, transitions, or launching new clients.

• Extensive knowledge of Medicare and Medi-Cal claims, including familiarity with CMS guidelines and regulatory requirements.

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

• Previous experience leading, coaching, or mentoring teams in a claims or healthcare operations setting.

• Strong analytical skills, capable of interpreting performance data and key performance indicators (KPIs).

• Exceptional communication, organizational, and decision-making abilities.

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

🏝️ Benefits

• Remote work options available.

• Equipment will be provided.

• Paid training to ensure your success.

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

• Paid Time Off (PTO).

• 7 paid holidays.

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