Senior Claims Operations Lead

Wellcove; Pensacola (FL); On-site; USD 55,000 - 75,000; Full time

Job summary

Wellcove Pensacola is seeking a Process Leader to guide a claims team and ensure efficient, accurate processing and timely delivery of results. You will mentor staff, coordinate with the Claims Manager, and promote continuous improvement across operational activities.

The role requires strong knowledge of insurance terminology, medical terminology, and coding practices, plus the ability to communicate with clients and internal teams, to uphold service quality and customer satisfaction.

Qualifications

• Must have advanced product knowledge and comprehensive understanding of insurance terminology.
• Must have knowledge of medical terminology and ability to read/interpret medical records.
• Familiarity with medical claim forms (HCFA-1500, UB04) and coding systems (ICD-9/10, CPT/HCPC/CDT).

Responsibilities

• Direct and coach a team to ensure efficient claim processing and timely delivery of business deliverables.
• Monitor operational activities of claim examiners to ensure accuracy and timeliness.
• Provide technical support, expert advice, and coaching to staff and clients.
• Identify opportunities to improve operational effectiveness and customer satisfaction.
• Identify skill gaps and arrange staff training to close gaps.
• Monitor KRAS, KPIS, SLA, AHT, Occupancy, Attrition, Shrinkage and manage team conflicts.
• Handle complaints, DOI, Appeal processes and client conversations.
• Draft process documentation including SOPs and issue trackers; perform quality audits.
• Speak with clients about process-related issues as needed.

Skills

Advanced product knowledge

Insurance terminology

Medical terminology

ICD-9/10 CPT/HCPC

Healthcare knowledge

Education

Certificate/degree from college or technical school

Job description

Wellcove Pensacola is seeking a Process Leader to guide a claims team and ensure efficient, accurate processing and timely delivery of results. You will mentor staff, coordinate with the Claims Manager, and promote continuous improvement across operational activities.

The role requires strong knowledge of insurance terminology, medical terminology, and coding practices, plus the ability to communicate with clients and internal teams, to uphold service quality and customer satisfaction.