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 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.

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 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 department and company standards • Analyze performance reports and determine team-member training needs • Oversee and assist with medical and dental claims review, research, adjudication, coverage determination, and issue resolution • Interpret benefit and policy provisions, provider status, and claims-processing guidelines • Support grievance and appeal research and responses for dispute resolution • Communicate business-process and procedure changes to team members • Collaborate with the Training Coordinator on initial and continued staff education • Oversee and assist with member, provider, employer, agent, and insurer inquiries by mail or email • Write business letters and prepare reports • Participate in interoffice, Claims leadership, strategic, internal, and departmental committees and workgroups • Maintain confidentiality and security of protected health information under PacificSource privacy policy and HIPAA • Coordinate business activities with key departments and improve interdepartmental processes using lean methodologies • Use visual boards and daily huddles to monitor KPIs and identify improvement opportunities • Participate in department meetings and communicate relevant information to the team • Meet department and company performance and attendance expectations • Perform other duties as assigned

🎯 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 PacificSource products, plan designs, provider relationships, and health insurance terminology • Basic working knowledge of Oregon Insurance Division rules and regulations • Thorough understanding of claims processing systems and operation • 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 in order to audit accurately • Advanced skills in medical terminology and CPT / ICD-10 coding • Effective and responsive leadership • Ability to work under time pressures and deal with difficult situations • Strong collaboration, organizational, planning, communication, critical-thinking, decision-making, influencing, and active-listening skills • Ability to read and comprehend written and spoken English • Ability to communicate clearly and effectively • Ability to stoop and bend, sit and/or stand for extended periods, perform repetitive typing/sorting/filing motions, and light lifting/carrying • Approximately 5% travel required

🏖️ Benefits

• Equal opportunity employment • Ergonomically configured equipment • Professional training and continued education • Team meetings and daily team Visual Board huddles • Opportunities to participate in workgroups, committees, and process improvement initiatives