Claims Lead

Our client provides a range of health solutions for rural communities. With new projects on the horizon, they are hiring a Claims Lead to help develop, evaluate, and manage health plan claim adjustments, projects, and Customer Service portal requests.

This Role Offers:

• Competitive base salary plus comprehensive benefits, including medical/dental/vision, 401(K), and more.
• Stable company with over seven decades of experience.
• Tight-knit culture focused on taking care of their employees.
• Ample opportunities for growth and career advancement.
• High employee tenure with low red tape culture. They hire professionals and trust their expertise, giving them room to make tangible impacts.

Focus:

• Assess individual and team performance on a regular basis and provide developmental feedback.
• Identify and escalate opportunities for efficiencies intended to reduce rework.
• Evaluate business processes and perform high level analysis to leverage opportunities for operational improvements.
• Perform initial root-cause analysis of workflow and break-fixes.
• Overall goal is to process claims accurately and efficiently while reducing administrative costs.
• Manage and supervise daily workflow and preparation of daily, weekly, monthly production and inventory reports to ensure business objectives are maintained within State and Federal compliance mandates.
• Contribute to the development of business and technical requirements for system improvements.
• Identify and coordinate training and tools to ensure staff members are operating at desired skill levels.

Skill Set:

• 3+ years leadership experience within a related healthcare field.
• 3+ years in claims processing.
• Strong knowledge of claims processing, procedures and systems, State, Federal and Medicare Regulations and Coordination of Benefits applications.
• Proven ability to manage issues by finding solutions and communicating changes effectively.
• Strong communication skills and ability to develop creative solutions to business challenges.
• Exhibit strong skills in reading, writing, and communicating at a professional level.
• Proficiency in managing multiple tasks and prioritizing work.
• Ability to supervise and lead others, think analytically, and make independent decisions.
• Ability to handle multiple and changing priorities.