Claims Team Lead: Lead, Optimize & Resolve

Jobtailor; Austin (TX); On-site; USD 70,000 - 95,000; Full time

Job summary

Jobtailor in Austin, TX is seeking a seasoned Claims Processing Lead to supervise a team of 4-7 Processors and Senior Processors, providing guidance on complex or escalated cases and acting as the primary point of contact for escalations.

You will oversee daily claims processing, review medical invoices, ensure timely payments, train new staff, track KPIs with management, and collaborate across departments to streamline workflows while maintaining compliance and accurate member records.

Qualifications

• Bachelor's degree or equivalent experience in a related field.
• 2-3 years of experience in healthcare, claims processing, or a related field, including 1-2 years of leadership experience.
• Experience with process improvement, team management, or case management is preferred.
• Experience with CRM systems, such as Salesforce, is a plus.
• Advanced knowledge of medical terminology, claims processing, and medical billing practices.
• Proficiency in working both independently and collaboratively within a fast-paced, team environment.
• High level of attention to detail, accuracy in documentation, and data entry.
• Critical thinking and problem-solving skills, especially when resolving escalated issues.
• Ability to multitask and adapt to changing priorities efficiently.

Responsibilities

• Lead a team of 4-7 Claims Processors and Senior Claims Processors, providing ongoing support, answering questions, and offering guidance in handling complex or escalated cases.
• Oversee daily claims processing tasks, ensuring timely and accurate handling of member claims, reviewing medical invoices, and processing payments in alignment with company guidelines and deadlines.
• Serve as the primary point of contact for escalated issues, working closely with members and providers to resolve disputes or sensitive cases.
• Assist in training new and junior staff members, providing coaching and feedback to help them grow and improve their performance.
• Work closely with Management to monitor department performance, track KPIs, and implement process improvements as needed.
• Coordinate with various departments to enhance the claims processing experience for members and ensure a seamless workflow.
• Identify inefficiencies within the team and recommend automation, system enhancements, or procedural changes to optimize claims processing.
• Ensure compliance with internal and external policies by maintaining accurate member records in the CRM system and conducting periodic audits of claims processed by the team.
• Handle direct communication with members, ensuring queries and escalations are managed with professionalism, empathy, and accuracy.

Skills

Claims Processing

Team Leadership

Process Improvement

Medical Terminology

CRM Systems

Data Entry

Attention to Detail

Education

Bachelor's degree or equivalent experience

Tools

Salesforce

Job description

Jobtailor in Austin, TX is seeking a seasoned Claims Processing Lead to supervise a team of 4-7 Processors and Senior Processors, providing guidance on complex or escalated cases and acting as the primary point of contact for escalations.

You will oversee daily claims processing, review medical invoices, ensure timely payments, train new staff, track KPIs with management, and collaborate across departments to streamline workflows while maintaining compliance and accurate member records.