Claims - Process Lead, Claims

Wellcove • PENSACOLA, FL

2d

About The Position

The role of a Claims Process Lead involves overseeing the claims processing workflow, ensuring compliance with regulations, and driving continuous improvement initiatives. Key responsibilities include: Managing Claims: Overseeing the adjudication and processing workflows for claims, ensuring accuracy and compliance. Team Leadership: Leading a team of claims processors, providing guidance, performance feedback, and training. Quality Assurance: Implementing and monitoring QA protocols to ensure high accuracy in claim payments. Problem Solving: Identifying and resolving issues in the claims lifecycle, collaborating with IT and Codebook teams. Policy Compliance: Ensuring all activities meet strict compliance standards and adhering to HIPAA and federal regulations. Process Improvement: Driving transformation initiatives and process optimization, and leading governance committee meetings. Customer Service: Providing excellent customer service and managing costs, timelines, quality, and delivery of claims.This role requires a strategic thinker, strong leadership skills, and a commitment to continuous improvement in claims handling practices.

Requirements

• Strategic thinker
• Strong leadership skills
• Commitment to continuous improvement in claims handling practices

Responsibilities

• Managing Claims: Overseeing the adjudication and processing workflows for claims, ensuring accuracy and compliance.
• Team Leadership: Leading a team of claims processors, providing guidance, performance feedback, and training.
• Quality Assurance: Implementing and monitoring QA protocols to ensure high accuracy in claim payments.
• Problem Solving: Identifying and resolving issues in the claims lifecycle, collaborating with IT and Codebook teams.
• Policy Compliance: Ensuring all activities meet strict compliance standards and adhering to HIPAA and federal regulations.
• Process Improvement: Driving transformation initiatives and process optimization, and leading governance committee meetings.
• Customer Service: Providing excellent customer service and managing costs, timelines, quality, and delivery of claims.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 101-250 employees