Claims Team Lead: Appeals & Process Leader (Hybrid Onsite)

Careington International; Frisco (TX); Hybrid; USD 65,000 - 90,000; Full time

Job summary

Careington International, a leading health services administrator, seeks a Claims Specialist Team Lead to manage high-level complaints and appeals within the Claims department. The role emphasizes leadership, time management, and multi-tasking to keep the department efficient.

The position starts hybrid with three days per week in Frisco, TX, with a planned transition to full onsite five days by Spring/Summer 2027, offering opportunities to mentor staff and improve claim processes.

Qualifications

• 1+ years of healthcare appeals/claims experience and benefit interpretation.
• 1+ years handling client plan documents and claims research, including dental plans.
• Proficient with MS Office applications; learns Careington systems quickly.

Responsibilities

• Manage escalated issues, complaints, and appeals to resolution.
• Support claims manager with questions from Specialists.
• Assist with training for Claims Specialists.
• Identify trends and report root causes.
• Review complex appeals and report trends to leadership.
• Draft resolution letters and ensure timely handling.
• Provide coaching feedback to team members.
• Reduce defects by identifying pre-payment adjudication issues.
• Support department initiatives to improve efficiency.
• Perform additional duties and special projects as needed.

Skills

Organized

Independent

Deadline-driven

Communication

Adaptability

Strong work ethic

Learning ability

Education

Associate degree

Tools

Adobe

Excel

Word

Outlook

Job description

Careington International, a leading health services administrator, seeks a Claims Specialist Team Lead to manage high-level complaints and appeals within the Claims department. The role emphasizes leadership, time management, and multi-tasking to keep the department efficient.

The position starts hybrid with three days per week in Frisco, TX, with a planned transition to full onsite five days by Spring/Summer 2027, offering opportunities to mentor staff and improve claim processes.