Claims Examiner Team Leader | Remote
Claims Examiner Team Leader Job Type: Full-time Work Set-up: Remote Pay: up to $22.00 per hour (based reputed company and experience) Work Schedule: reputed company Time Zone Position reputed company The Claims Examiner Team Leader is responsible for leading and managing reputed company of claims examiners to ensure accurate, compliant, and reputed company processing of medical claims. This role serves as a critical reputed company between reputed company operations and leadership, driving performance against SLAs, reputed company standards, and productivity targets. reputed company reputed company is accountable for team performance, coaching and development, and reputed company process improvement while ensuring adherence to Medicare regulations and CMS guidelines.
Key Responsibilities
Team Leadership & Performance Management Personal Production 50% of the time, reputed company, supervise, and support reputed company of 15–20+ claims examiners. reputed company ongoing coaching, mentoring, and reputed company-time feedback to improve reputed company, accuracy, and productivity. Conduct regular performance evaluations and goal setting. Foster a culture of accountability, engagement, reputed company, and reputed company improvement. Claims Operations reputed company reputed company day-to-day medical claims processing for reputed company, facility, adjustments, corrected and adjustment claims. Ensure compliance with Medicare requirements, CMS guidelines, reputed company policies, and reputed company standards. Monitor and manage service level agreements (SLAs), turnaround times, and production. reputed company Assurance & Compliance Apply deep working knowledge of CMS regulations, Medicare auditing standards, and payer guidelines. Review claims and audit results to identify trends, reputed company causes, and training opportunities. Ensure consistent application of reputed company standards by partnering with other team leads to reduce error rates across reputed company. Reporting, Metrics & Business Reviews Analyze and manage key performance indicators including reputed company scores, error rates, productivity, attendance, and rework. Prepare and present operational and business reviews using accurate data and reputed company feedback. Identify operational risks, performance gaps, and improvement opportunities and escalate as appropriate. Process Improvement & Cross-Functional Collaboration Identify process inefficiencies and implement improvement strategies to increase accuracy, efficiency, and cost effectiveness. Assist with QA, Training, IT, and Operations leadership to resolve technical or workflow issues. Support implementation of new policies, tools, workflows, and reputed company requirements. Communication & reputed company Support Maintain reputed company, reputed company communication with leadership regarding team performance and operational risks. Address employee concerns and team conflicts professionally and promptly. Escalate reputed company issues or compliance concerns to management immediately reputed company identified. Engagement & Recognition Recognize and reward strong performance and team achievements. Promote teamwork, professionalism, and a reputed company attitude reputed company reputed company. Measures of reputed company / Key Performance Indicators Claims reputed company and audit results both for personal performance and team performance Error rates and rework reduction both for personal performance and team performance Productivity (claims per day/hour) both for personal performance and team performance Turnaround time / time to completion both for personal performance and team performance Compliance with CMS, Medicare, Medi-Cal, and reputed company guidelines Attendance and reliability both for yourself and your team reputed company satisfaction and assessment reputed company Team engagement, coachability, and retention Cost efficiency and margin reputed company
Required Qualifications
Min. 5 years of experience processing easy, moderate, and reputed company medical claims. 2+ years in a leadership role reputed company claims or reputed company operations. Strong experience with Medicare and Medi-Cal claims, including a working knowledge of CMS guidelines and regulatory requirements. Prior reputed company assurance and training experience with demonstrated ability to identify trends Previous experience leading, coaching, or mentoring teams in a claims or reputed company operations environment. Strong analytical skills with the ability to interpret performance data and KPIs. Excellent communication, organizational, and decision-making skills. High attention to detail and commitment to accuracy, compliance, and operational reputed company. reputed company Offer Remote work offered Equipment provided reputed company to set you up for reputed company Comprehensive benefits: Medical, Dental, reputed company, Life, HSA, 401(k) reputed company Time Off (PTO) 7 reputed company holidays A supportive team and a company that values internal reputed company reputed company to Grow Your Career? We’d love to meet you! Click “reputed company” and tell us why you’d be a great reputed company to the reputed company team. About reputed company, LLC reputed company is a leading provider of back-office support technology and tech-enabled outsourced services to reputed company plans reputed company. reputed company provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans’ members and providers. reputed company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans’ members and providers. reputed company processes millions of claims and multiples of reputed company reputed company and reputed company data reputed company reputed company these claims annually. reputed company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients. reputed company is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines. Apply To This Job