SHS Team Lead

BCS Financial Corporation • Oakbrook Terrace, IL

6d

About The Position

The Team Lead plays a key role in delivering an exceptional customer experience by making prompt, accurate, and empathetic decisions on supplemental health insurance claims. These claims may include products such as critical illness, hospital indemnity, accident indemnity, and fixed payment indemnity. In this role, you will work closely with customers, healthcare providers, and internal teams to collect and evaluate information, interpret policy terms, and determine claim outcomes. Clear and compassionate communication with customers is essential, especially when requesting additional documentation to support their claims. Success in this position requires sound judgment, meticulous attention to detail, and a strong commitment to customer care.
You will assist Director of SHS Claim Services in documenting claims processes and procedures and creating training materials.
You will conduct QA audits for processed claims and assist in preparing monthly QA reporting.
You will also work closely with assigned employer groups to help ensure smooth transition to BCS.

Requirements

• High School Diploma required.
• Bachelor’s degree or commensurate experience required
• 8+years of claims experience with the following Supplemental Health claim types: Fixed Indemnity (Limited Benefit Medical)
• Accident Indemnity
• Hospital Indemnity
• Critical Illness
• Medical claims
• Solid understanding of Supplemental Health claim processes and medical terminology.
• Familiarity with federal and state regulations.
• Knowledge of current COB, Medicare, HIPAA, CPT, ICD-10,HI Revenue Codes, and benefit plan interpretation preferred.

Nice To Haves

• Insurance industry designations preferred
• Knowledge of VBA is preferred but not required

Responsibilities

• Deliver empathetic, customer-first service throughout all interactions.
• Evaluate new Supplemental Health claims promptly and accurately.
• Analyze information against policy terms and procedural guidelines.
• Document claim decisions thoroughly in the system.
• Communicate effectively with customers and internal and external stakeholders.
• Develop and maintain claim management plans for optimal outcomes.
• Ensure compliance with regulatory and operational standards.
• Foster a collaborative and professional team environment.
• Conduct QA audits.
• Manage and train others to manage certain claims queues.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 101-250 employees