Lead Medical Claims Examiner

About the role

Who We Are Lawelawe is a Native Hawaiian Owned Small Disadvantaged Business (NHO SDB) that specializes in providing a range of services to federal government clients, including program management, digital solutions, human capital and training, and medical staffing. Lawelawe leverages our NHO status to secure federal contracts that not only drive business success but also support our overall mission to uplift economically disadvantaged Native Hawaiian families and preserve the Native Hawaiian heritage.

Who You Are An experienced, detail-oriented claims professional who can manage sensitive medical, financial, and legal information while helping a team deliver accurate and timely results. You are organized, dependable, comfortable working in multiple electronic systems, and able to guide coworkers, coordinate priorities, and identify issues requiring management attention. You communicate professionally and understand the importance of protecting private and sensitive information.

How You Will Make An Impact You will support medical claims and healthcare cost recovery activities for a federal healthcare customer. In addition to performing claims-examination duties, you will assist the Program Manager with workload distribution, daily workflow coordination, quality checks, and the scheduling of shared workstation usage. Your contributions will help the team maintain balanced workloads, meet deadlines, and recover healthcare costs owed to the Government.

Work Environment This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.

Responsibilities

• Assist the Program Manager with distributing and balancing claims workloads based on case complexity, employee capacity, priorities, and deadlines.
• Monitor case progress, identify backlogs or workload imbalances, and recommend adjustments to the Program Manager.
• Coordinate shared workstation usage and the rotating on-site schedule under the Program Manager’s direction, communicating approved assignments and schedule changes to team members.
• Identify workstation scheduling conflicts, coverage gaps, and workspace constraints and elevate them to the Program Manager.
• Provide procedural guidance, peer training, and mentoring to Claims Examiners, including assistance with onboarding new team members.
• Maintain an assigned claims workload while performing lead-coordination responsibilities.
• Monitor shared organizational email inboxes and physical mail for incoming claims, correspondence, and inquiries.
• Process new referrals and establish Medical Affirmative Claims and Third-Party Collection case files.
• Enter claims and case information into ACMP and other required government systems.
• Maintain accurate electronic