Claims Team Leader — Lead, Coach & Elevate Quality

pacificsource; Boise (ID); On-site; USD 65,000 - 90,000; Full time

Job summary

PacificSource in Idaho is seeking a Claims Supervisor to lead a team of Claims Analysts and support staff. You will oversee claims production, quality, and adherence to policy guidelines, while guiding coaching, training, and performance evaluations.

The role emphasizes collaboration across departments, compliance with HIPAA and privacy policies, and driving process improvements through lean methods and daily huddles.

Qualifications

• Minimum of 3 years of experience in closely related insurance field or 3 years of supervisory experience required.
• Requires high school diploma or equivalent.
• Knowledge of PacificSource products, plan designs, provider relationships and health insurance terminology.
• Advanced PC skills including Microsoft Word and Excel.
• Ability to type using a standard keyboard, operate 10-key pad, multi-line telephone system and fax machine.
• Strong research skills to evaluate claims for audit accuracy.

Responsibilities

• Provide supervision, coaching, training, evaluation and leadership to assigned staff to ensure claims processing quality.
• Evaluate team performance and training needs using performance reports and data.
• Oversee claims processing to ensure service quality for members, providers, employers and other insured parties.
• Review and research medical and dental claims, determine coverage based on contracts and guidelines; handle disputes and grievances.
• Communicate changes in processes and procedures to team members.
• Coordinate with Training Coordinator on education for staff and onboarding.

Skills

Leadership

Coaching

Performance management

Process improvement

HIPAA compliance

Education

High school diploma

Tools

Microsoft Word

Microsoft Excel

10-key pad

Job description

PacificSource in Idaho is seeking a Claims Supervisor to lead a team of Claims Analysts and support staff. You will oversee claims production, quality, and adherence to policy guidelines, while guiding coaching, training, and performance evaluations.

The role emphasizes collaboration across departments, compliance with HIPAA and privacy policies, and driving process improvements through lean methods and daily huddles.