Claims Team Lead II

🔥 12 hours ago

🇺🇸 United States – Remote

💵 $64k - $75k / year

⏰ Full Time

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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HealthEdge

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2005

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

Healthcare • Consulting • Healthcare Insurance

HealthEdge is a company that specializes in providing advanced solutions for healthcare payers through its HealthRules Solutions Suite. This suite includes a comprehensive digital claims administration processing system, care management workflow solutions, and payment integrity solutions, which aim to enhance operational efficiency and improve quality of care for health plans. By leveraging integrated technology and automation, HealthEdge helps health plans eliminate data silos, increase payment accuracy, and elevate member experience, thereby transforming the healthcare landscape for better collaboration and accessibility.

📋 Description

• Directly manage a staff of typically 12–15 claims examiners and adjusters • Know and meet client-specified guidelines • Monitor and manage downline staff productivity targets and financial and procedural accuracy standards • Collaborate on special projects, including process documentation, training, quality audits, and surge activity for clients • Communicate with management to address issues and concerns and take preventive measures ensuring processing accuracy and quality • Assemble and assign projects involving provider data, authorizations, enrollment, or other information • Perform other duties assigned by leadership • Deliver a high-quality claims operation while meeting or exceeding service-level agreements and KPIs • Drive operational excellence and build competencies for delivery • Interact extensively with client organizations and multiple stakeholders

🎯 Requirements

• 5+ years healthcare claims processing experience HRP • Solid understanding and ability to effectively lead a claims team • Good verbal and written communication skills • Microsoft application experience, especially Excel is suggested • ICD-10, CPT and HCPCS coding is a plus • Knowledge of physician billing and hospital coding (ICD-10, HCPC, CPT-4), medical terminology, and authorization requirements • Willingness to learn new skills • Team collaborator • Strong work ethic • Ability to adapt quickly to a fast-paced environment • Self-starter and quick learner • Ability to collaborate as a team player • Ability to coach the team to reach its full potential • Dependability and ability to work independently • Candidates may be required to complete a pre-employment criminal background check

🏖️ Benefits

• Remote work environment • Hybrid or remote work environment • May require travel dependent on company needs • Reasonable accommodations for individuals with disabilities • Equal opportunity employer committed to workforce diversity