Claims Team Lead

About Us

Health Admins is a leading force in healthcare administration, committed to becoming a premier technology-driven healthcare platform. Our vision is to continuously improve the healthcare experience for our members and clients through innovative, efficient solutions.

Summary/Objective

The Claims Team Lead for Claims Processing plays 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.

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.
• Aid 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.
• Cook up 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.
• A high level of attention to detail, accuracy in documentation, and data entry.
• Critical thinking and problem-solving skills, especially when resolving escalated issues.
• The 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).