Team Lead - Claims

We are actively hiring for a Team Lead- Claims! The Team Lead - Claims is responsible for providing the technical product and system knowledge to the Claims teams, both internal and offshore, as applicable to the program. This will include participation in coaching/mentoring, training and problem solving. This position also requires assisting management with overseeing daily inventory, turnaround time, and quality work ensuring that key performance objectives are met as well as assisting with creating an environment that stimulates an enthusiastic, motivating, high-performance culture.

Responsibilities:

• Assists and supports all team members and managers with claims processing, outreach requests to other departments for any additional documentation/information needed and escalation requests.
• Prepares and sends out the daily department inventory email, as well as taking part in the inventory meetings to tackle time sensitive tasks.
• Maintaining required departmental production and quality standards.
• Interprets and disseminates information via the desk procedures located in the processing manual.
• Suggests methods to improve area operations (efficiency and service).
• Processes claims as needed and/or works the inquiry/adjustment cases/services as needed.
• Allocates work to team members as needed.
• Keeps manager advised of status of workload and identify problems for which help is needed.
• Interacts effectively with all levels across the company. Build solid internal and external customer relationships.
• May participate in and/or lead departmental and interdepartmental workgroups and/or projects.
• Follow and promote regulations and company rules and policies as outlined in the Employee Manual.
• Other duties as assigned.

• College degree or equivalent work experience preferred.
• Minimum - 4 years of experience in the health insurance industry examining and adjudicating medical claims.
• Excellent verbal and written communication skills needed to effectively relate any issues identified or enhancements needed to internal departments and vendors.
• Intermediate proficiency in MS Office products.
• Ability to see the "big picture," with ability to make strong and reliable recommendations for improving system capabilities to support operational areas efficiently.
• Experience in project management, operational/process analysis, design, and improvement a plus.
• Ability to manage multiple assignments simultaneously while maintaining quality standards and meeting assigned deadlines.
• Ability to make decisions and support them with documentation.
• Must speak and write fluent English.
• Employee is required to have at minimum an internet speed of 75 Mbps (standard high-speed internet access).

• Flexibility to work in an office and/or at-home, remote office environment.
• Overtime and/or schedule flexibility are occasionally necessary in this position. Individual may be required to attend key business/departmental meetings and/or perform certain business critical job functions outside of normal working hours.
• Physical Demands: Must be able to communicate internally and externally through receiving and responding to auditory and visual methods.