Claims Team Leader

Job not on LinkedIn

🔥 0 minutes ago

🏰 Missouri – Remote

🏰 Missouri – Remote

💵 $50.8k - $81.3k / year

⏰ Full Time

🟠 Senior

👻 Ghost score 0%

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.

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PacificSource Health Plans

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1933

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

PacificSource Health Plans is a healthcare provider that offers a range of health insurance solutions, including plans for individuals, families, and employers. Their offerings include Medicare and Medicaid plans, dental coverage, and administrative services for small and large groups. Committed to member care, PacificSource emphasizes customer service and provides various resources for health management, including mental health support and wellness programs.

📋 Description

• Supervise, coach, train, evaluate, and provide leadership to Claims Analysts and support staff • Manage claims production and quality to meet or exceed company standards • Resolve claims adjudication issues • Hire, train, coach, counsel, and evaluate team member performance • Analyze performance reports and determine training needs • Oversee and assist with medical and dental claims review, research, coverage determination, and issue resolution • Interpret benefit and policy provisions • Support dispute resolution, grievances, and appeals through research and responses • Communicate business process and procedure changes to team members • Collaborate with the Training Coordinator on initial and continued staff education • Respond to mail and email inquiries, write business letters, and prepare reports • Participate in interoffice, leadership, strategic, and internal committees • Coordinate business activities with key departments • Support process improvement using lean methodologies, visual boards, daily huddles, and KPI monitoring • Attend department meetings and team visual board huddles • Follow PacificSource privacy policies and HIPAA requirements • Travel approximately 5% of the time

🎯 Requirements

• Minimum of 3 years of experience in a closely related insurance field or 3 years of supervisory experience • High school diploma or equivalent • Thorough understanding of claims processing systems and operations • Advanced PC skills, including Microsoft Word and Excel • Ability to type using a standard keyboard and accurately operate a 10-key pad, multi-line telephone system, and fax machine • Research skills and ability to evaluate claims for accurate auditing • Advanced skills in medical terminology and CPT / ICD-10 coding • Basic working knowledge of Oregon Insurance Division rules and regulations • 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

🏖️ Benefits

• Work-from-home arrangement • Equal opportunity employment • Ergonomically configured equipment • Training and continued education opportunities • Collaborative workgroups and leadership development opportunities