Claims Specialist Team Lead

Careington International Corporation•Frisco, TX

20h•Hybrid

About The Position

The Claims Specialist Team Lead manages and resolves high-level complaints, issues, and appeals, and helps ensure the Claims department operates efficiently. The role supports the Claims Manager and Claims Specialists through training, guidance, and feedback, and helps identify and address trends and errors. The position is currently hybrid, requiring in-office attendance three days per week at the Corporate Office in Frisco, Texas. It is expected to transition to a fully onsite schedule five days per week sometime during Spring/Summer 2027.

Requirements

At least 1 year of healthcare experience, specifically in appeals, claims, and/or compliance, as well as benefit interpretation.
At least 1 year of experience with client plan documents, claims research, and/or letter writing, including documentation and interpretation of dental insurance plans.
Advanced computer skills and experience with Adobe, Excel, Word, and Outlook.
Ability to learn and use current office applications and Careington systems.
Strong organization and ability to manage multiple tasks effectively.
Initiative and ability to work independently with minimal supervision.
Ability to work in a deadline-driven environment.
Clear oral and written communication skills and ability to interact effectively with internal and external contacts.
Ability to apply knowledge after training to research and resolve claims appropriately.
Strong work ethic and ability to adapt as business plans evolve.
Ability to operate standard office equipment and keyboards; walk short distances; stand, walk, sit, talk, hear, use hands to handle or feel objects or controls, reach, stoop, kneel, bend, crouch, and lift up to 25 pounds; and meet specified vision requirements.

Nice To Haves

Associate degree or equivalent combination of education and experience.

Responsibilities

Manage escalated issues, complaints, and appeals through resolution.
Assist the Claims Manager with questions from Claims Specialists.
Assist with training Claims Specialists.
Identify trends and emerging issues, and report them with recommended solutions.
Review and analyze complex appeals.
Report trends in claims appeals and issues to leadership for root cause analysis.
Facilitate interpretation of plan policies and benefit guidelines.
Draft resolution letters.
Ensure timely handling in accordance with client and regulatory timeframes.
Provide leaders with feedback for coaching and mentoring team members based on review findings.
Reduce defects by proactively identifying pre-payment claim errors and adjudication trends, and recommending solutions.
Support department initiatives to improve overall efficiency.
Perform additional assigned duties, including special projects as needed.