Claims Team Leader

Job not on LinkedIn

🔥 0 minutes ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $50.8k - $81.3k / year

⏰ Full Time

🟠 Senior

👻 Ghost score 20%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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

PACIFICSOURCE

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1933

Not-for-profit health plans

📋 Description

• Supervise, coach, train, evaluate, and provide leadership to Claims Analysts and support staff • Manage claims production and quality to meet department and company standards • Resolve claims adjudication issues • Hire, train, coach, counsel, and evaluate team member performance • Oversee and assist with claims processing for members, providers, employers, agents, and other insurance companies • Interpret benefit and policy provisions accurately • Review and research medical and dental claims and determine coverage based on contracts, provider status, and processing guidelines • Investigate and settle claims issues; support grievance and appeal dispute resolution • Communicate business process and procedure changes to team members • Coordinate initial and continued staff education with the Training Coordinator • Answer mail and email inquiries, write business letters, and prepare reports • Serve on interoffice, strategic, internal, and department committees • Participate in the Claims leadership peer group to support cross-team communication, collaboration, and process efficiency • Maintain HIPAA and PacificSource privacy compliance • Coordinate activities through partnerships with key departments • Assist with process improvement using lean methodologies, visual boards, daily huddles, and KPI monitoring • Participate in department meetings and workgroups • Perform other duties as assigned

🎯 Requirements

• Minimum of 3 years of experience in a closely related insurance field or 3 years of supervisory experience required • High school diploma or equivalent required • Thorough understanding of claims processing systems and operation • Basic working knowledge of Oregon Insurance Division rules and regulations • Advanced PC skills, including Microsoft Word and Excel • Ability to type using a standard keyboard, operate a 10-key pad accurately, multi-line telephone system, and fax machine • Research skills and ability to evaluate claims in order to audit accurately • Advanced skills in medical terminology and CPT / ICD-10 coding • Effective leadership, collaboration, communication, critical thinking, decision making, influencing, active listening, and organizational/planning skills • Ability to work under time pressures and deal with difficult situations • Ability to read and comprehend written and spoken English • Ability to communicate clearly and effectively • Ability to meet department and company performance and attendance expectations • Ability to travel approximately 5% of the time

🏖️ Benefits

• Equal opportunity employment • Ergonomically configured equipment • Professional development and continued education through collaboration with the Training Coordinator • Employee participation in committees, workgroups, and strategic initiatives • Community, social justice, equity, diversity and inclusion initiatives