Claims Examiner Team Leader

Job not on LinkedIn

🔥 2 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $22 / hour

⏰ Full Time

🟠 Senior

📋 Claims Specialist

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Imagenet LLC

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

⚕️ Healthcare Insurance

🛍️ eCommerce

☁️ SaaS

💰 Private Equity Round on 2022-12

Healthcare Insurance • eCommerce • SaaS

Imagenet LLC is a leading provider of business continuity services for healthcare organizations, specializing in digital mailroom solutions, claims adjudication, contact center operations, and workflow management. With over two decades of experience and a reputation for enhancing efficiency and accuracy, Imagenet partners with health plans to streamline processes and improve member satisfaction. Their services are designed to reduce claims turnaround times, increase processing capacities, and lower contact center wait times. By integrating scalable solutions tailored to specific needs, Imagenet enables healthcare organizations to accelerate productivity and mitigate operational challenges.

📋 Description

• Responsible for leading and managing a team of claims examiners • Ensure accurate, compliant, and timely processing of medical claims • Serve as a critical bridge between frontline operations and leadership • Drive performance against SLAs, quality standards, and productivity targets • Accountability for team performance, coaching and development, and process improvement • Ensure adherence to Medicare regulations and CMS guidelines • Oversee day-to-day medical claims processing • Monitor and manage service level agreements (SLAs), turnaround times, and production • Apply deep working knowledge of CMS regulations, Medicare auditing standards, and payer guidelines • Review claims and audit results to identify trends and training opportunities • Analyze and manage key performance indicators including quality scores, error rates, productivity, and attendance • Prepare and present operational and business reviews • Identify operational risks, performance gaps, and improvement opportunities

🎯 Requirements

• Min. 5 years of experience processing easy, moderate, and complex medical claims • 2+ years in a leadership role within claims or healthcare operations • Strong experience with Medicare and Medi-Cal claims, including a working knowledge of CMS guidelines and regulatory requirements • Prior quality assurance and training experience with demonstrated ability to identify trends • Previous experience leading, coaching, or mentoring teams in a claims or healthcare operations environment • Strong analytical skills with the ability to interpret performance data and KPIs • Excellent communication, organizational, and decision-making skills • High attention to detail and commitment to accuracy, compliance, and operational excellence

🏖️ Benefits

• Remote work offered • Equipment provided • Paid training to set you up for success • Comprehensive benefits: Medical, Dental, Vision, Life, HSA, 401(k) • Paid Time Off (PTO) • 7 paid holidays • A supportive team and a company that values internal growth