Claims Processing Team Lead — Operations & QA

GuideWell; San Antonio (TX); Hybrid; USD 75,000 - 100,000; Full time

Benefits offered by this job

Medical, dental, vision insurance

Life and disability insurance

401(k) employer match

Paid time off and holidays

Wellness program

Job summary

GuideWell is seeking an Assistant Manager of Claims Processing to lead a team of Claims Examiners, drive performance, and ensure timely processing of complex claims. The role includes hiring, onboarding, coaching, and close collaboration with internal audits and IT teams.

The ideal candidate will have supervisory experience, healthcare claims expertise and strong communication, with proficiency in MS Office and WebTPA systems. This position is based in Texas and offers comprehensive benefits.

Qualifications

• 2+ years related work experience as a claims examiner or adjudication on a computerized claims system in healthcare.
• 1+ years direct supervisory/management experience
• Bachelor's degree or related equivalent work experience
• Judgment, decision-making and analytical thinking
• Ability to multi-task and learn quickly
• Concise written and oral communication with conflict handling
• Experience processing all types of medical claims
• Motivated with a strong work ethic
• Ability to maintain rapport with clients, providers and staff
• Proficiency with MS Office
• Experience with WebTPA systems
• Knowledge of CPT coding and fee establishment

Responsibilities

• Manage a team of Claims Examiners and serve as SME.
• Hire new employees with Talent Acquisition; onboard and train.
• Manage and review claims, set priorities to meet deadlines.
• Review metrics for quality and coordinate with Internal Audit.
• Coach employees; conduct 1:1s and performance appraisals.
• Recognize team members and foster a positive environment.
• Handle disciplinary actions with HR; ensure compliant processes.
• Timekeeping and PTO/OT requests approvals.
• Process high-dollar threshold claims and review complex items.
• Investigate questions from members or clients.
• Assist manager with member/provider call backs.
• Communicate with clients and internal teams to resolve issues.
• Complete claim testing for benefit changes, renewals, and new groups.
• Review benefit issues with IT/Plan Build and update grids.
• Assist with audits and with SilverSkills inquiries

Skills

Analytical thinking

Decision making

Verbal and written communication

Conflict resolution

Multi-tasking

MS Office proficiency

WebTPA systems

Education

Bachelor's degree or related equivalent experience

Tools

WebTPA systems

MS Office

Job description

GuideWell is seeking an Assistant Manager of Claims Processing to lead a team of Claims Examiners, drive performance, and ensure timely processing of complex claims. The role includes hiring, onboarding, coaching, and close collaboration with internal audits and IT teams.

The ideal candidate will have supervisory experience, healthcare claims expertise and strong communication, with proficiency in MS Office and WebTPA systems. This position is based in Texas and offers comprehensive benefits.