Lead - Claims Quality & Support

Responsibilities

• Build & facilitates QA for claims compliance with our policies and procedures, adherence to Terms & Conditions, and communication guidelines.
• Provides direct feedback to agents, both positive and constructive, with the goal of providing the best service to our customers.
• Helps to handle complex issues, escalations and problems, and acts as a subject matter expert in Provider Operations to help agents with questions.
• Identifies recurring issues, process gaps, and broader coaching opportunities and suggests solutions. Also aids in devising, developing, and rolling out the corrections to these identified areas.
• This may also include training and supporting the materials and facilitation of said training.
• Acts as first level lead which can provide coverage for supervisor vacations or absences.
• Reviews and provides P-Card authorizations for Out of Network work.
• Supports on-call activities and may require weekend coverage on a rotating schedule.
• Is a self-starter and performs work under minimal supervision.
• Is a strong team player and works well with other supervisors and managers within the Service Operations organization as well as other cross-functional teams.
• Other duties as assigned.

Qualifications

• 4-6 years of Service Management experience.
• Strong organizational, sense of urgency and prioritization skills.
• Strong analytical and problem-solving skills.
• Strong effective verbal and written communication skills.
• High School Diploma or GED required.
• Bachelor's degree preferred, or equivalent experience.