Lead Recalculation Examiner — Claims Team Lead

CommunityCare, Inc.; Tulsa (OK); On-site; USD 65,000 - 90,000; Full time

Job summary

CommunityCare, Inc. is seeking a Lead Recalculation Examiner to guide a claims team in Tulsa, OK. The role focuses on maximizing team potential, delivering training, and resolving complex claims scenarios. The Lead will liaise between Claims and other departments and support customers and the company’s mission.

The successful candidate will be supportive and communicative, with strong organizational skills and a commitment to quality in claims processing and service delivery.

Qualifications

• High school diploma or equivalent required.
• Three years related work experience in claims processing, data entry or medical billing.
• One year of claims processing experience within CommunityCare or another healthcare environment is required.

Responsibilities

• Coordinates daily workflow among employees, providing updates to supervisor.
• Assists supervisor with communicating regularly to employees any changes that have direct impact on inquiry responses.
• Effectively solves problems that demonstrate balance of company and customer needs.
• Provides motivation to the team to achieve organizational goals that contributes to the growth of the company.
• Contributes to the creation of a pleasant working environment that serves to inspire the team.
• Identifies training needs and trains staff in areas of claims and company policies.
• Enters claims information using claims software to process claim payments, allowable amounts, limitations, exclusions and denial of claims and review system adjudication for errors.
• Reviews and investigates appropriate claims for coordination of benefit, worker’s compensation and third-party coverage. Performs clerical duties associated with the processing and completion of claims including pending letters, requests for the loading of information for providers, members or authorizations.
• Handles the most difficult or complex claims or claims situations requiring significant experience and knowledge.
• Consistently learn and adapt to changes related to claims processing, benefits, limits and regulations.
• Assist Claims Supervisor in performing additional duties where needed or as directed.

Skills

Leadership

Coaching

Communication

Time management

Education

High school diploma or equivalent

Tools

Microsoft Office

Job description

CommunityCare, Inc. is seeking a Lead Recalculation Examiner to guide a claims team in Tulsa, OK. The role focuses on maximizing team potential, delivering training, and resolving complex claims scenarios. The Lead will liaise between Claims and other departments and support customers and the company’s mission.

The successful candidate will be supportive and communicative, with strong organizational skills and a commitment to quality in claims processing and service delivery.