Claims Team Lead Hybrid Williston, VT

Gainwell Technologies LLC•Williston, VT

12d•$58,800 - $84,000•Hybrid

About The Position

The Claims Team Lead is responsible for providing day-to-day leadership, training, quality oversight, and operational support for the Claims Team. This role serves as a subject matter expert for claims processing, coordinates workflow priorities, monitors performance and SLA compliance, supports staff development, and acts as a liaison between team members, management, system support teams, and external stakeholders. The Team Lead ensures claims are processed accurately, timely, and in accordance with policy, regulatory requirements, and operational standards.

Requirements

Claims processing systems, policies, procedures, and documentation expertise.

Responsibilities

Provide guidance, coaching, and support to Claims Team staff while fostering a positive and collaborative work environment.
Conduct one-on-one meetings, train new employees, and provide ongoing education and support to team members.
Assist staff with claims processing, policy, system, and procedural questions.
Perform quality assurance reviews, identify processing errors, and communicate audit findings with constructive feedback.
Ensure compliance with claims policies, procedures, service level agreements (SLAs), and audit requirements.
Monitor claims inventory, aging reports, suspended and pending claims, and related workflows to identify and resolve processing delays.
Generate and analyze operational reports, claims data, dashboards, and performance metrics to identify trends and process improvement opportunities.
Serve as a primary escalation point and collaborate with managers, operations, systems teams, and external partners to resolve claims-related issues.
Maintain expertise in claims processing systems, policies, procedures, and documentation while assisting with system troubleshooting and enhancements.
Provide leadership support through coaching, mentoring, project participation, and management backup while effectively managing multiple priorities and deadlines.
Perform other duties as assigned by the supervisor or management.