Claims Team Lead

BEST DOCTORS INSURANCE SERVICES LLC•Miami, FL

About The Position

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.

Requirements

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
Associates Degree or commensurate with experience
Minimum of 3 years experience in Health Insurance Industry

Nice To Haves

Billing/Coding Certification preferred

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