Medical Coding Quality Lead – Claims Team

Socket.dev; United States; Remote; USD 65,000 - 111,000; Full time

Job summary

PacificSource is seeking a claims leadership role to supervise and guide a multidisciplinary team responsible for medical, dental, and vision claims processing. The role focuses on quality, training, and adherence to policies while improving efficiencies and collaboration with Compliance and Grievance teams.

Travel is minimal; the position requires strong knowledge of insurance terminology and claims auditing.

Qualifications

• Minimum 4 years of complex claims management experience including auditing, billing, research, and recovery.
• At least 1 year of supervisory experience is required.
• Experience in self-funded claims administration preferred.

Responsibilities

• Provide supervision, coaching, training, and leadership to assigned staff. Ensure claims processing meets department and company standards for production and quality.
• Evaluate team member performance using reports and metrics to identify training needs and support departmental goals.
• Oversee the Fraud, Waste, and Abuse claim review process in collaboration with Compliance.
• Support the team in delivering exceptional claims service across medical/dental/vision lines.
• Oversee and assist with review, research of medical claims and determine coverage based on contract and guidelines.
• Communicate process changes to team members and collaborate on education for staff.

Skills

Leadership

Coaching

Training

Communication

Research

Auditing

Education

High school diploma or equivalent

Tools

Microsoft Word

Excel

10-key

Fax machine

Job description

PacificSource is seeking a claims leadership role to supervise and guide a multidisciplinary team responsible for medical, dental, and vision claims processing. The role focuses on quality, training, and adherence to policies while improving efficiencies and collaboration with Compliance and Grievance teams.

Travel is minimal; the position requires strong knowledge of insurance terminology and claims auditing.