Claims Team Lead

JOB PURPOSE:

Claims team lead will be responsible for effectively supporting, guiding and developing the claims team; providing mentorship and problem resolution on the day to day needs of the team.

ESSENTIAL JOB DUTIES AND RESPONSIBILITIES:

• Ensure claims team is working in an integrated fashion to promote consistency in claims adjudication
• Facilitate interdepartmental processes and communications with other supporting areas ( Ex: Medical team, Quality Control, etc. )
• Oversee the day-to-day work of team members to ensure claims guidelines and benefits are applied to each claim adjudicated
• Manage inventory and productivity to ensure all turnaround times and goals are met
• Maintain inventory, productivity and KPIs reports to constantly review and monitor work volumes/inventory to ensure we are in line with department goals.
• Deliver outstanding ad effective service to internal and external customers
• Perform internal and external trainings on benefit, processes or guidelines
• Support all claim committee case reviews and committee management
• Support the execution and implementation of assignments, initiatives or team priorities
• Provide effective problem resolutions
• Deliver efficient and effective claims adjudication of any claim
• Participate in staff recruitment, interviewing, hiring, orientations, performance plans
• Ensure that operating processes are optimized to fulfill business necessity
• Act as a technical resource to the development of processes, software and business integrations, etc
• Master all job duties for claims adjudicators
• Provide support and back up to the management team

DESIRED MINIMUM QUALIFICATIONS:

• Solid written and verbal communication skills with internal and external clients
• Comfort in working in a global business environment within a multicultural client base
• Basic understanding of the regulatory requirements of each market within the Latam region
• Track record in leading teams to deliver flawless service in a fast paced and demanding environment
• Ability to delegate, plan and communicate effectively
• Strong analytical abilities and attention to detail
• Excellent time management skills and ability to prioritize
• Ability to coordinate and organize meetings, prepare presentations, and public speaking
• Efficient in medical terminology and health insurance principles
• Proficiency in Microsoft product suite (i.e. Microsoft Office, Word, Excel, etc.)
• Strong analytical, problem solving and negotiating skills
• Ability to adapt quickly in fast paced environment
• Complete Fluency in English, Spanish (Portuguese a plus)
• Proven ability to work independently and meet determined deadlines
• Ability to navigate and enter data utilizing multiple systems and screens

EDUCATION AND EXPERIENCE:

• Associates Degree or commensurate with experience
• Billing/Coding Certification preferred
• Minimum of 3 years experience in Health Insurance Industry