Claims Team Lead

CROWN ADMINISTRATORS•Austin, TX

2d•Remote

About The Position

The Claims Team Lead for Claims Processing bridges Claims Processors and the Management team to support smooth operations and efficient medical claims processing. The role combines hands-on claims processing with leadership responsibilities, guiding a team of Claims Processors and assisting with escalated cases. The Claims Team Lead supports senior leadership by tracking KPIs, improving workflows, and mentoring team members to help meet department and company goals. The position is remote in Texas.

Requirements

Bachelor's degree or equivalent experience in a related field.
2–3 years of experience in healthcare, claims processing, or a related field, including 1–2 years of leadership experience.
Strong leadership skills and the ability to manage and motivate a team.
Advanced knowledge of medical terminology, claims processing, and medical billing practices.
Ability to work independently and collaboratively in a fast-paced team environment.
Exceptional communication skills and a customer-centric mindset.
Strong attention to detail and accuracy in documentation and data entry.
Critical thinking and problem-solving skills, particularly when resolving escalated issues.
Ability to multitask and adapt efficiently to changing priorities.
Familiarity with claims management software and medical billing processes.
Proficiency with Google Suite and CRM systems.

Nice To Haves

Experience in process improvement, team management, or case management.
Experience with CRM systems such as Salesforce; Salesforce is preferred.

Responsibilities

Lead and support a team of 4–7 Claims Processors and Senior Claims Processors, answering questions and guiding them through complex or escalated cases.
Oversee daily claims processing, including reviewing medical invoices and ensuring member claims and payments are handled accurately and on time in accordance with company guidelines.
Serve as the primary contact for escalated issues and work with members and providers to resolve disputes or sensitive cases.
Assist with training new and junior staff by providing coaching and feedback.
Work with Management to monitor department performance, track KPIs, and implement process improvements.
Coordinate with other departments to improve the member claims experience and support seamless workflows.
Identify team inefficiencies and recommend automation, system enhancements, or procedural changes.
Maintain accurate member records in the CRM system and conduct periodic audits of claims processed by the team to support compliance with internal and external policies.
Communicate directly with members and handle their queries and escalations professionally, empathetically, and accurately.