Claims Team Lead

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🔥 1 minute ago

🐊 Florida – Remote

🐊 Florida – Remote

⏰ Full Time

🟠 Senior

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Wellcove

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1989

🛡️ Insurance

🏥 Healthcare

☁️ SaaS

Insurance • Healthcare • SaaS

Wellcove is a third‑party administrator (TPA) focused on the senior market and long‑term care (LTC) benefits. Its cloud‑native LTC Now platform and AssuriCare services provide automated claim administration, eligibility determination, auto‑adjudication, payment processing, digital care management, provider matching, risk evaluation/analytics, and business process outsourcing for carriers, state retirement plans, and reinsurers. The company emphasizes automation, payment integrity, and tailored administrative solutions for long‑term care and Medicare supplement administration.

📋 Description

• A process leader leads, monitors, and administrates a group of employees to achieve goals. • Provides daily direction and communication to employees so that the business deliverables are intact, efficient, and knowledgeable manner. • Monitoring operational activities of claim examiners to ensure claims are processed accurately and timely. • Provide technical support, expert advice, and coaching assistance to team members and clients. • Identify new opportunities to improve operational effectiveness and customer satisfaction and make recommendations for improvements. • Identify skill gaps and ensure training is provided to further develop staff. • Should manage team conflict and any people related issue. • Handle complaints, DOI, Appeal etc. Adhere to process reporting, able to draft process documents, including SOP, Update tracker, issue logs etc. • Ability to do quality audit for team process. • Ability to speak to client on process related issues and able to handle the calls with client.

🎯 Requirements

• One to Two years certificate/degree from college or technical school; or 2-5 years related experience and/or training; or equivalent combination of education and experience. • Must possess advance product knowledge, comprehensive understanding of insurance terminology and definitions, core knowledge of company and department processes and procedures related to the ability to complete job responsibilities/duties in a proficient and professional manner. • Must have knowledge of medical terminology, ability to read and interpret most medical records/notes, ICD-9/10 and CPT/HCPC/CDT coding; Familiarity with different medical claim forms, i.e. HCFA-1500 and UB04 forms; working knowledge of Insurance Industry and/or Healthcare.