Claims Team Lead

Responsibilities Lead a team of 4-7 Claims Processors and Senior Claims Processors, providing ongoing support, answering questions, and offering guidance in handling complex or escalated cases. Oversee daily claims processing tasks, ensuring timely and accurate handling of member claims, reviewing medical invoices, and processing payments in alignment with company guidelines and deadlines. Serve as the primary point of contact for escalated issues, working closely with members and providers to resolve disputes or sensitive cases. Assist in training new and junior staff members, providing coaching and feedback to help them grow and improve their performance. Work closely with Management to monitor department performance, track KPIs, and implement process improvements as needed. Coordinate with various departments to enhance the claims processing experience for members and ensure a seamless workflow. Identify inefficiencies within the team and recommend automation, system enhancements, or procedural changes to optimize claims processing. Ensure compliance with internal and external policies by maintaining accurate member records in the CRM system and conducting periodic audits of claims processed by the team. Handle direct communication with members, ensuring queries and escalations are managed with professionalism, empathy, and accuracy. Requirements Bachelor's degree or equivalent experience in a related field 2-3 years of experience in healthcare, claims processing, or a related field, including 1-2 years of leadership experience Experience in process improvement, team management, or case management is preferred. Experience with CRM systems, such as Salesforce, is a plus. Advanced knowledge of medical terminology, claims processing, and medical billing practices. Proficiency in working both independently and collaboratively within a fast-paced, team environment. High level of attention to detail, accuracy in documentation, and data entry. Critical thinking and problem-solving skills, especially when resolving escalated issues. Ability to multitask and adapt to changing priorities efficiently. Core Competencies Demonstrates expertise in claims processing, team leadership, and process improvement within the healthcare sector. Proficient in managing escalated issues, ensuring compliance, and enhancing operational efficiency through effective communication and collaboration. Highest-signal resume keywords Claims Processing Team Leadership Process Improvement Medical Terminology CRM Systems ATS Optimization Keywords Hard Skills Claims Processing Medical Billing Data Entry Process Improvement KPI Tracking Soft Skills Critical Thinking Problem-Solving Attention to Detail Communication Empathy Industry Keywords Healthcare Claims Processing Medical Terminology Escalated Issues Compliance Tools & Technologies CRM Systems Salesforce #J-18808-Ljbffr Jobtailor