Lead Claims Recalculation Specialist

CommunityCare HMO Inc.; Tulsa (OK); On-site; USD 55,000 - 85,000; Full time

Job summary

CommunityCare HMO Inc. seeks a Lead Recalculation Examiner to guide a claims team and maximize performance. You will work with the Claims Supervisor to ensure efficient workflow and provide instruction and training to staff.

The role emphasizes solving complex claims, coordinating with other departments, and building team skills to better support customers and the company’s mission. A hands-on, communicative leader will thrive here.

Qualifications

• High school diploma or equivalent required; three years in claims processing, data entry or medical billing.
• Experience in community care or healthcare environment preferred.
• Ability to read claims processing manuals, medical terms, and CPT codes.

Responsibilities

• Coordinate daily workflow among employees and provide updates to supervisor.
• Communicate changes impacting inquiry responses to staff.
• Resolve complex claims and coordinate with other departments.
• Motivate the team to achieve goals and contribute to company growth.
• Create a pleasant working environment to inspire the team.
• Identify training needs and train staff in claims and company policies.
• Enter claims information using claims software to process payments and review adjudication for errors.
• Review and investigate claims for coordination of benefits, workers' comp and third-party coverage; manage related clerical tasks.
• Handle the most difficult or complex claims requiring significant experience and knowledge.
• Learn and adapt to changes related to claims processing, benefits, limits and regulations.
• Assist Supervisor with additional duties as needed.

Skills

Self-motivation

Claims processing

Managed care terms

Coaching

Communication skills

Learning agility

Motivation

Relationship building

Microsoft Office

Time management

Claims manuals

Quality standards

Background check

Network authorization

Education

High school diploma or equivalent

Tools

Claims software

Job description

CommunityCare HMO Inc. seeks a Lead Recalculation Examiner to guide a claims team and maximize performance. You will work with the Claims Supervisor to ensure efficient workflow and provide instruction and training to staff.

The role emphasizes solving complex claims, coordinating with other departments, and building team skills to better support customers and the company’s mission. A hands-on, communicative leader will thrive here.