Healthcare Claims Team Lead: Growth & Coaching

Provalus; Edenton (NC); On-site; USD 65,000 - 85,000; Full time

Benefits offered by this job

Company-paid healthcare

Job summary

Provalus is seeking a Healthcare Insurance Customer Support Team Lead to oversee a team handling claims processing, member and provider inquiries, and customer service activities for health insurance products. This role blends hands-on leadership with compliance expertise to ensure accurate and timely resolutions.

The ideal candidate will supervise daily team activities, coach staff, monitor KPIs, and escalate complex issues while maintaining strict PHI/PII confidentiality in a HIPAA-driven

Qualifications

• 3+ years in healthcare, health insurance, or claims processing.
• Experience leading a team (team lead/supervisor).
• HS Diploma or GED; associate/bachelor preferred.
• Onsite work at Provalus office; no remote.
• Strong HIPAA/PHI, PII confidentiality knowledge.
• Excellent communication and coaching skills.

Responsibilities

• Supervise daily activities of Healthcare Customer Support Representatives, including scheduling and workload distribution.
• Coach and develop team members; onboard new hires on claims processing procedures and HIPAA requirements.
• Monitor KPIs (claims turnaround, quality, resolution rate) and provide feedback.
• Handle complex claims, billing disputes, denials, and appeals with leadership intervention.
• Serve as escalation point for urgent/complex claims and compliance concerns.
• Guide team in researching claims status, benefits, eligibility, and coverage details.
• Review notes and documentation for accuracy and compliance; coach on standards.
• Identify root causes in claims issues and recommend process improvements.
• Collaborate with HR/Management for hiring, performance management and disciplinary processes.
• Ensure confidentiality of PHI/PII and HIPAA compliance across the team.
• Lead team meetings and communicate updates, policy changes and goals.

Skills

Team leadership

Coaching

Communication

Interpersonal skills

Education

HS Diploma or GED

Associate or Bachelor's degree preferred

Tools

CRM systems

Claims processing platforms

Job description

Provalus is seeking a Healthcare Insurance Customer Support Team Lead to oversee a team handling claims processing, member and provider inquiries, and customer service activities for health insurance products. This role blends hands-on leadership with compliance expertise to ensure accurate and timely resolutions.

The ideal candidate will supervise daily team activities, coach staff, monitor KPIs, and escalate complex issues while maintaining strict PHI/PII confidentiality in a HIPAA-driven