The Team Lead, Claims assists the Claims Manager with managing the day to day operations of claims. She/he directly supervises a team of Claims Examiners assigned to new claims, provider correspondence and special handling. Additional tasks include oversight of letter generation process and review of vendor activity to align with performance expectations. The incumbent must carry out supervisory responsibilities in accordance with the organization's policies and applicable laws.
Receives predetermined work assignments that are subject to a moderate level of control and review. Directs subordinates in completion of assignments using established guidelines, procedures and policies. Reviews and provides oversight of assignments to ensure accuracy.
Duties and Responsibilities Include:
- Monitors staff production and performance in order to meet corporate performance goals. Provides ongoing coaching and feedback to staff.
- Ensures the accurate and timely adjudication of claims
- Plans and organizes the daily operation of the Service Department, including processing payroll for staff and reviewing attendance.
- Analyzes and trends inquiry types to identify process improvement opportunities, including development of educational material for staff.
- Administers disposition according to contractual benefits and company procedures
- Provides technical support to claims processors
- Interprets automated inventory reports to establish controls that ensure constant flow of existing claims inventory
- Monitors risk factors that would expose operations and put HF in jeopardy of compliance and prompt pay violations
- Collaborates with Claims Examiners to identify system challenges that impact the outcome of a claim
- Assigns, monitors & reviews progress and accuracy of work. Directs efforts and provides technical guidance on more complex issues
- Identifies and coordinates staff training needs to ensure uniform professional responses.
- Additional duties as assigned
- Experience in Claims Processing
- Experience coaching and counseling employees
- Experienced in Microsoft Office suite or products including Excel, Word, Outlook and PowerPoint
- Experience using Power MHS, CCMS, and MACESS
- High School Diploma OR GED from an accredited institution
- Bachelor’s Degree from an accredited institution
- Planning and Organization Skills/Time Management
- Strong verbal and written communication skills
- Supervisory experience leading a team of 10 or more employees
- Experience working in Health Insurance Environment
- Ability to work independently and receive projects needing a moderate level of control and review
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
If you have a disability under the Americans with Disability Act or a similar law, and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.
EEO Law Poster and Supplement