Job Summary:

The Team Lead, Claims is responsible for managing and maintaining workflow/assignments to ensure timely processing of claims and research and resolution workload.

Essential Functions:

• Direct day-to-day staff activities to ensure service and performance objectives are achieved
• Manage and maintain workflow/assignments to ensure timely processing of claims and research and resolution workload
• Ensure prompt pay requirements are met and maintained on a monthly basis
• Document process changes and new procedures to promote consistency in claims operations
• Monitor level of intakes, email, mail and special projects; notify management of levels outside of established thresholds
• Create, review, revise and enforce company and department policies and procedures
• Responsible for direct supervision of staff including quality review, performance feedback, disciplinary issues and merit/bonus appraisal review
• Create and update ongoing staffing plan to address issues that may impact service or provider/internal customer satisfaction
• Oversee orientation and training of new claims representatives
• Observe staff’s ability to utilize computer system and reference materials and make recommendations for improving performance as appropriate
• Maintain time sheets for non-exempt employees
• Participate in managing external vendor relationships
• Perform any other job duties as requested

Education and Experience:

• Associates Degree or equivalent years of relevant work/education experience required
• Eighteen months claims processing experience in an HMO or related industry, is preferred
• Previous supervisory/leadership experience preferred

Competencies, Knowledge and Skills:

• Intermediate level skills in Microsoft Word, Excel and Outlook
• Facets Claims system knowledge preferred
• Effective written and verbal communication skills
• Leadership experience and skills
• Ability to work independently and within a team environment
• Attention to detail
• Ability to effectively support diverse personalities and work styles
• Critical listening and thinking skills
• Training/teaching skills
• Strategic management skills
• Proper grammar usage
• Time management skills
• Customer service orientation
• Decision making/problem solving skills
• Knowledge of claims related applications and software
• Ability to identify and recommend process improvements

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.