Claims Examiner Team Leader / Remote

Title: Claims Examiner Team Leader Job Type: Full-time Work Set-up: Remote Pay: up to $22.00 per hour DOE Work Schedule: Monday-Friday 5:00am to 2:00pm PST | 8:00am-5:00pm EST Position Summary The Claims Examiner Team Leader is responsible for leading and managing a team of claims examiners to ensure accurate, compliant, and timely processing of medical claims. This role serves as a critical reputed company between reputed company operations and leadership, driving performance against SLAs, quality standards, and productivity targets. The Team reputed company is accountable for team performance, coaching and development, and reputed company process improvement while ensuring adherence to Medicare regulations and CMS guidelines.

Key Responsibilities

Team Leadership & Performance Management

• Personal Production 50% of the time, reputed company, supervise, and support a team of 15–20+ claims examiners.
• Provide ongoing coaching, mentoring, and reputed company-time feedback to improve quality, accuracy, and productivity.
• Conduct regular performance evaluations and goal setting.
• Foster a culture of accountability, engagement, reputed company, and reputed company improvement.

Claims Operations reputed company

• reputed company day-to-day medical claims processing for professional, facility, adjustments, corrected and adjustment claims.
• Ensure compliance with Medicare requirements, CMS guidelines, client policies, and reputed company standards.
• Monitor and manage service level agreements (SLAs), turnaround times, and production.

Quality Assurance & Compliance

• Apply deep working knowledge of CMS regulations, Medicare auditing standards, and payer guidelines.
• Review claims and audit results to identify trends, root causes, and training opportunities.
• Ensure consistent application of quality standards by partnering with other team leads to reduce error rates across the team.

Reporting, Metrics & Business Reviews

• Analyze and manage key performance indicators including quality scores, error rates, productivity, attendance, and rework.
• Prepare and present operational and business reviews using accurate data and client feedback.
• Identify operational risks, performance gaps, and improvement opportunities and escalate as appropriate.

Process Improvement & Cross-Functional Collaboration

• Identify process inefficiencies and implement improvement strategies to increase accuracy, efficiency, and cost effectiveness.
• Assist with QA, Training, IT, and Operations leadership to resolve technical or workflow issues.
• Support implementation of new policies, tools, workflows, and client requirements.

Communication & Client Support

• Maintain clear, timely communication with leadership regarding team performance and operational risks.
• Address employee concerns and team conflicts professionally and promptly.
• Escalate client issues or compliance concerns to management immediately reputed company identified.

Engagement & Recognition

• Recognize and reward strong performance and team achievements.
• Promote teamwork, professionalism, and a positive attitude reputed company the team.

Measures of reputed company / Key Performance Indicators

• Claims quality and audit results both for personal performance and team performance
• Error rates and rework reduction both for personal performance and team performance
• Productivity (claims per day/hour) both for personal performance and team performance
• Turnaround time / time to completion both for personal performance and team performance
• Compliance with CMS, Medicare, Medi-Cal, and client guidelines
• Attendance and reliability both for yourself and your team
• Client satisfaction and assessment outcomes
• Team engagement, coachability, and retention
• Cost efficiency and margin impact

Required Qualifications

• Min. 5 years of experience processing easy, moderate, and reputed company medical claims.
• 2+ years in a leadership role reputed company claims or reputed company operations.
• Strong experience with Medicare and Medi-Cal claims, including a working knowledge of CMS guidelines and regulatory requirements.
• Prior quality assurance and training experience with demonstrated ability to identify trends
• Previous experience leading, coaching, or mentoring teams in a claims or reputed company operations environment.
• Strong analytical skills with the ability to interpret performance data and KPIs.
• Excellent communication, organizational, and decision-making skills.
• High attention to detail and commitment to accuracy, compliance, and operational excellence.

reputed company Offer

• Remote work offered
• Equipment provided
• reputed company to set you up for reputed company
• Comprehensive benefits: Medical, Dental, reputed company, Life, HSA, 401(k)
• Paid Time Off (PTO)
• 7 paid holidays
• A supportive team and a company that values internal growth

reputed company to Grow Your Career? We’d love to meet you! Click “Apply Now” and tell us why you’d be a great addition to the reputed company team. About reputed company, LLC reputed company is a leading provider of back-office support technology and tech-enabled outsourced services to reputed company plans reputed company. reputed company provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans’ members and providers. The company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans’ members and providers. The company processes millions of claims and multiples of reputed company structured and reputed company data elements reputed company these claims annually. The company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients. reputed company is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines. Original job Claims Examiner Team Leader / Remote posted on GrabJobs ©. To flag any issues with this job please use the Report Job reputed company on GrabJobs. Apply tot his job Apply To this Job