Processing Team Lead
About The Position
The Processing Team Lead oversees the daily operations and performance of the Claims Processing team, ensuring departmental KPIs, quality standards, productivity goals, and service commitments are consistently achieved. The role provides leadership, training, and guidance to Claims Processors while maintaining accountability for inventory management, backlog reduction, and minimizing claim aging. The Processing Team Lead collaborates with Plan Builders, the CSS Team Lead, Claims Management, and other business partners to improve auto-adjudication performance, resolve processing challenges, support year-end initiatives, and ensure timely claim resolution.
Requirements
- At least 3 years of progressive experience in healthcare, insurance, client services, claims operations, or a related field.
- One year of leadership experience in a supervisory or team lead capacity.
- Strong knowledge of claims adjudication, benefit structures, accumulators, and Coordination of Benefits (COB).
- Experience managing claim inventory, backlog reduction initiatives, and aging claim performance.
- Ability to analyze operational data, identify trends, and implement effective solutions.
- Strong verbal and written communication skills.
- Excellent organizational, prioritization, and time management abilities.
- Proficiency in Microsoft Office applications, particularly Excel and reporting tools.
- Ability to build effective working relationships with processors, management, Plan Builders, the CSS Team Lead, and other internal business partners.
Nice To Haves
- Associate's or Bachelor's degree preferred.
Responsibilities
- Monitor and manage team performance against established KPIs, productivity goals, quality standards, and turnaround time expectations.
- Oversee inventory management, backlog reduction efforts, and aging claim performance to ensure claims are processed within established service standards.
- Monitor workload distribution and prioritize resources to maintain inventory levels and minimize aged claims.
- Partner with the CSS Team Lead on year-end processing activities, aging inventories, claim status inquiries, and cross-departmental workflow issues.
- Provide day-to-day leadership, training, coaching, and guidance to Claims Processors.
- Generate and analyze claims processing, inventory, productivity, quality, and auto-adjudication reports, and communicate trends to management.
- Monitor auto-adjudication outcomes and work with Plan Builders to identify issues, provide feedback, and support resolution through implementation.
- Serve as an escalation point for complex claims, claim inventory concerns, and operational questions.
- Identify process improvement opportunities that increase efficiency, reduce inventory, and improve claim turnaround times.
- Ensure compliance with plan provisions, departmental procedures, and company policies.
- Partner with management to communicate team performance, operational challenges, and opportunities for improvement.
- Perform other duties as required.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
No Education Listed
