Claims Team Lead

National Healthcare Solutions, Inc. • Miami, FL

21h • Hybrid

About The Position

The Claims Team Lead is responsible for providing guidance and support to a team of claims adjudicators and coordinators, helping ensure the accurate and timely processing of insurance claims. This role involves leading by example, resolving complex cases, supporting team development, and serving as a point of escalation—all while ensuring compliance with company policies and regulatory standards. The Team Lead plays a key role in promoting collaboration, efficiency, and service excellence within the claims team.

Requirements

• High school diploma or equivalent required
• In-depth understanding of insurance principles and claims handling procedures
• Demonstrated expertise in assigned claims areas with a track record of success
• Strong leadership skills with the ability to motivate and guide team members
• Excellent analytical and problem-solving capabilities
• Clear and effective communication skills, both verbal and written
• Strong interpersonal skills with the ability to collaborate across teams
• Proficiency in industry-related systems, tools, and technology
• Knowledge of medical coding (preferred)
• Ability to thrive in a fast-paced environment and meet tight deadlines

Nice To Haves

• Experience in the insurance and/or healthcare industry
• Bilingual in Spanish and/or Portuguese
• Proven experience in process improvement and change management to drive operational efficiency
• Advanced knowledge of accounts receivable practices and billing systems

Responsibilities

• Assign claims to team members based on workload and assignment of responsibility (AORs).
• Monitor individual claim progress and key performance metrics.
• Provide coaching, constructive feedback, and development opportunities to team members.
• Support resolution of performance issues and team conflicts.
• Review escalated claims for accuracy, completeness, and compliance with company policies and procedures.
• Investigate and resolve complex claims requiring in-depth analysis.
• Identify and escalate potentially fraudulent claims in accordance with protocols.
• Contribute to the implementation of strategies that improve claims processing efficiency and accuracy.
• Monitor and report on customer satisfaction related to claims handling.
• Generate performance reports, including metrics such as claim volume, productivity, and turnaround times.
• Analyze performance data to identify trends, gaps, and areas for continuous improvement.
• Share performance insights and recommendations with management.
• Address and resolve escalated customer inquiries or complaints related to claims.
• Foster and maintain positive relationships with internal departments and external stakeholders.

Benefits

• Medical, Dental, and Vision Insurance
• 401(k) Retirement Plan
• Life Insurance
• Short-Term Disability (STD) Coverage
• Long-Term Disability (LTD) Coverage
• Paid Time Off (PTO)
• Paid Holidays
• Hybrid Work Model (combination of remote and in-office work)
• Wellness Programs, including free access to our building gym
• A vibrant, engaging work environment that values and supports our employees’ growth, well-being, and success

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED