Claims Team Lead

CROWN ADMINISTRATORS•Austin, TX

3d•Remote

About The Position

The Claims Team Lead for Claims Processing bridges Claims Processors and the Management team to ensure smooth operations and efficient medical claims processing. The role combines hands-on claims processing with leadership responsibilities, including guiding Claims Processors, supporting escalated cases, and assisting senior leadership with KPI tracking, workflow improvements, and team mentoring. The position helps ensure department and company goals are met efficiently. The role is remote in Texas. The company describes itself as a technology-driven healthcare administration platform focused on improving the healthcare experience through innovative and efficient solutions.

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 experience is preferred.

Responsibilities

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