Claims Team Lead II

HealthEdge Software, Inc.; Northern (KY); Hybrid; USD 64,000 - 75,000; Full time

Job summary

HealthEdge Software, Inc. seeks a Claims Team Lead to manage a staff of 12–15 associates supporting US health plan clients. You will ensure adherence to client guidelines and drive accuracy and performance across the claims operation.

Remote work across US time zones is available; you will collaborate on projects, monitor productivity, and coach the team to meet SLAs and KPIs. Candidates should have 5+ years in healthcare claims processing, strong leadership, Excel proficiency, and knowledge of

Qualifications

• 5+ years healthcare claims processing experience HRP

Responsibilities

• Be responsible for directly managing a staff of typically 12 - 15 associates
• Be responsible for knowing and meeting client-specified guidelines
• Be responsible for monitoring and management of the downline staff’s productivity targets and financial and procedural accuracy standards as established by management
• Collaborate on special projects as assigned by the manager; special projects can include process documentation development, training, quality audits, assisting with surge activity for the client(s), or any other project as determined by management
• Establish and maintain an appropriate level of communication with management to address issues and concerns and take preventive measures that ensure processing accuracy and quality
• Assemble and assign projects that may include provider data, authorizations, enrolment, or other information
• Perform other duties as assigned by your leadership

Skills

Staff leadership

Healthcare claims processing

Communication

Excel

ICD-10/CPT coding

Physician/hospital coding knowledge

Willingness to learn

Team collaboration

Strong work ethic

Tools

Excel

Job description

Overview

HealthEdge® offers AI-powered operational infrastructure for health insurance companies, guaranteeing an enduring financial edge in an increasingly competitive market. We're experiencing strong market momentum, with a growing number of health plans choosing HealthEdge to modernize their operations and compete more effectively. As we expand, we're investing in the people who power that growth, making this a pivotal moment to join us and shape the future of healthcare technology. Learn more at HealthEdge.com.

At UST HealthProof, you will join a fast paced, growing company in our mission to reshape the future of health insurance through significantly reducing administrative costs and building better healthcare experiences for our health plans customers and their members. By creating a modern, cloud based, Best-In-Class core administration ecosystem, we have made healthcare more affordable and helped our health plans operate more efficiently. Through member and provider touchpoints with less friction, we have created real impact for members.

UST HealthProof is run by leaders with strong health plan and technology backgrounds who have start-up mindsets and an environment of support where individual growth is nurtured. You will be supporting our proven core admin solutions and business process-as-a-service (BPaaS) operations to provide transparency, improve operational efficiency, and break down operational barriers to scale and drive strategic growth.

UST HealthProof is looking for Claims Team Lead, reporting to the Claims Manager. The Claims Team Lead is responsible for a team of typically 12-15 claims examiners, adjusters, extensive interaction with client organization, and multiple stakeholders. The Claims Team Lead is accountable for delivering a high-quality claims operation, meeting and exceeding all service level agreements and KPIs, driving operational excellence, and building competencies for delivery.

As a Claims Team Lead at UST HealthProof, this is your opportunity to

• Be responsible for directly managing a staff of typically 12 - 15 associates
• Be responsible for knowing and meeting client-specified guidelines
• Be responsible for monitoring and management of the downline staff’s productivity targets and financial and procedural accuracy standards as established by management
• Collaborate on special projects as assigned by the manager; special projects can include process documentation development, training, quality audits, assisting with surge activity for the client(s), or any other project as determined by management
• Establish and maintain an appropriate level of communication with management to address issues and concerns and take preventive measures that ensure processing accuracy and quality
• Assemble and assign projects that may include provider data, authorizations, enrolment, or other information
• Perform other duties as assigned by your leadership

You bring:

• 5+ years healthcare claims processing experience HRP
• Solid understanding and ability to effectively lead a claims team
• Good communication skills (verbal and written)
• Microsoft application experience, especially Excel is suggested
• ICD-10 CPT and HCPCS coding is a plus
• Knowledge base of physician billing and hospital coding (ICD-10, HCPC, CPT-4), medical terminology, and authorization requirements
• Willingness to learn new skills
• Team collaborator
• Strong work ethic

For this role, we value:

• The ability to adapt quickly to a fast-paced environment
• A self-starter and quick learner
• Team player with an ability to collaborate
• Ability to coach the team to reach their full potential
• Dependability and the ability to work independently

Geographic Responsibility: Remote, US

Type of Employment: Full-time, permanent

Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:

• The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.

• Work across multiple time zones in a hybrid or remote work environment.

• Long periods of time sitting and/or standing in front of a computer using video technology.

• May require travel dependent on company needs.

The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required. HealthEdge reserves the right to modify, add, or remove duties and to assign other duties as necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990. Candidates may be required to go through a pre-employment criminal background check.

HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities.

#LI-Remote

The annual US base salary range for this position is $64,000 to $75,000. This salary range may cover multiple career levels at HealthEdge. Final compensation will bedeterminedduring the interview process and is based on a combination of factors including, but not limited to,your skills, experience,qualificationsand education.