Claims Team Lead

Claims Team Lead

Health Admins is a leading force in healthcare administration, on a journey to become a premier technology-driven healthcare platform. Our vision is anchored in a commitment to Getting Better Every Step of the Way. We are dedicated to providing innovative, efficient solutions that elevate the healthcare experience for the members and clients we serve. We are currently seeking a driven and experienced Claims Team Lead who acts with professional discipline and shares our passion for continuous improvement to join our team.

What We Are Looking For

Our ideal candidate will play a crucial role in managing our claims environment, optimizing its performance, and driving continuous improvements to support our business goals and enhance our service delivery.

Every Team Member is Driven by a Commitment to Live out These Values:

• Operate as an Owner
• Act with Professional Discipline
• Pursue Progress Through Change
• Treat Service as a Privilege

Employees are expected to embrace our core values by being "A Hero in Action." These values lay the foundation for the way we engage with each other and with our clients. They form the guardrails for our decision making and approach to problem solving.

Summary/Objective:

The Claims Team Lead for Claims Processing bridges Claims Processors and the Management team, ensuring smooth operations and process efficiencies in managing medical claims. This role combines hands-on involvement in claims processing with leadership duties, guiding a team of Claims Processors and assisting with escalated cases. The Claims Team Lead will support the Senior Leadership team in tracking KPIs, improving workflows, and mentoring team members, ensuring that the department and company goals are met efficiently.

Key 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.

Skills Required:

• Strong leadership skills with the ability to manage and motivate a team.
• Advanced knowledge of medical terminology, claims processing, and medical billing practices.
• Proficiency in working both independently and collaboratively within a fast-paced, team environment.
• Exceptional communication skills with a customer-centric mindset.
• 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.

Education/Experience:

• 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.

Technical Knowledge:

• Familiarity with claims management software and medical billing processes.
• Proficient in using Google Suite and CRM systems (Salesforce preferred)

What We Offer

• Competitive salary and benefits package
• Dynamic and innovative work environment
• Opportunities for professional growth and development
• Remote work flexibility

Equal Opportunity Statement

We are deeply committed to building a workplace and global community where inclusion is not only valued but prioritized. We are proud to be an equal opportunity employer, seeking to create a welcoming and diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, family status, marital status, sexual orientation, national origin, genetics, neuro diversity, disability, age or veteran status, or any other non-merit based or legally protected grounds. We are committed to providing reasonable accommodation to qualified individuals with disabilities in the employment application process.