Claims Team Lead

About VUMI®

VUMI® (VIP Universal Medical Insurance Group) is an international health insurance company dedicated to providing premier medical insurance products and VIP healthcare services globally. With offices in Panama, Ecuador, Colombia, and beyond, VUMI® offers unique benefits and extensive global coverage. Privately owned and backed by over 35 years of healthcare industry experience, VUMI® employs a diverse team of 500+ professionals and is part of a leading international healthcare group. Join a top team of healthcare professionals driving innovation and excellence at one of the leading IPMI organizations.

About You

• A knowledgeable and driven insurance professional with a strong understanding of claims handling procedures and insurance principles.
• Hands-on experience in the areas you lead, with a proactive, solutions-oriented mindset and a passion for continuous improvement.
• Guiding and supporting team members, resolving complex claims, and maintaining high standards of accuracy and compliance.
• A confident communicator, able to handle escalations with professionalism, and fostering strong working relationships across teams.
• Bilingual in Spanish and/or Portuguese, comfortable in multicultural environments, and thriving in dynamic, fast-paced settings.
• Background in insurance or healthcare, along with skills in process improvement, billing systems, and performance analysis, making you a valuable contributor to operational excellence.
• Led by example, embracing challenges, and committed to delivering exceptional service.

POSITION SUMMARY

The Claims Team Lead is responsible for providing guidance and support to a team of claims adjudicators and coordinators, ensuring accurate and timely claim processing. This role involves leading by example, resolving complex cases, supporting team development, and serving as a point of escalation, all while ensuring compliance with company policies and regulatory standards. The Team Lead plays a key role in promoting collaboration, efficiency, and service excellence within the claims team.

ESSENTIAL FUNCTIONS

• Assign claims to team members based on workload and assignment of responsibility (AORs).
• Monitor individual claim progress and key performance metrics.
• Provide coaching, constructive feedback, and development opportunities to team members.
• Support resolution of performance issues and team conflicts.
• Review escalated claims for accuracy, completeness, and compliance with company policies and procedures.
• Investigate and resolve complex claims requiring in-depth analysis.
• Identify and escalate potentially fraudulent claims in accordance with protocols.
• Contribute to the implementation of strategies that improve claims processing efficiency and accuracy.
• Monitor and report on customer satisfaction related to claims handling.
• Generate performance reports, including metrics such as claim volume, productivity, and turnaround times.
• Analyze performance data to identify trends, gaps, and areas for continuous improvement.
• Share performance insights and recommendations with management.
• Address and resolve escalated customer inquiries or complaints related to claims.
• Foster and maintain positive relationships with internal departments and external stakeholders.

MINIMUM QUALIFICATIONS & SKILLS

• High school diploma or equivalent required.
• In-depth understanding of insurance principles and claims handling procedures.
• Demonstrated expertise in assigned claims areas with a track record of success.
• Strong leadership skills with the ability to motivate and guide team members.
• Excellent analytical and problem-solving capabilities.
• Clear and effective communication skills, both verbal and written.
• Strong interpersonal skills with the ability to collaborate across teams.
• Proficiency in industry-related systems, tools, and technology.
• Advanced knowledge of accounts receivable practices and billing systems (preferred).

PRFERED QUALIFICATIONS

• Bilingual in Spanish and/or Portuguese.
• Proven experience in process improvement and change management to drive operational efficiency.

BENEFITS

• Medical, Dental, and Vision Insurance.
• 401(k) Retirement Plan.
• Life Insurance.
• Short-Term Disability (STD) Coverage.
• Long-Term Disability (LTD) Coverage.
• Paid Time Off (PTO).
• Paid Holidays.
• Hybrid Work Model (combination of remote and in-office work).
• Wellness Programs, including free access to our building gym.
• A vibrant, engaging work environment that values and supports our employees’ growth, well-being, and success.

WORKING CONDITIONS

• Reasonable accommodation may be made to enable individuals with disabilities to perform the essential function.
• The role primarily operates in an indoor, climate-controlled office setting working in close proximity to others.
• No travel required.

Safety Hazard of the Job

• Minimal Hazards including potential ergonomic risks from prolonged sitting or repetitive motions.