Senior Claims Team Lead for Process Excellence

pacificsource; Springfield (OR); On-site; USD 65,000 - 90,000; Full time

Job summary

PacificSource in Oregon is seeking a Claims Supervisor to lead and coach a team of Claims Analysts, ensuring accurate processing and adherence to policy.

You will oversee production, resolve adjudication issues, hire, train, and evaluate staff, and collaborate with departments to improve processes using lean methods.

Minimum 3 years in insurance or supervisory role; high school diploma required; strong knowledge of claims systems, Word/Excel, and HIPAA/privacy compliance.

Qualifications

• Minimum of 3 years of experience in closely related insurance field or 3 years of supervisory experience.
• High school diploma or equivalent is required.
• Ability to interpret benefits and policies and coach others to apply them accurately.

Responsibilities

• Provide supervision, coaching, training, evaluation and leadership to assigned staff. Assure claims processing, production and quality meet department and company standards.
• Evaluate performance of team members and identify training needs based on performance data.
• Oversee claims processing service to members, providers, employers and other insurers; interpret benefits and policy provisions.
• Lead review and research of medical and dental claims; resolve coverage issues and guide grievances/appeals with other departments.
• Communicate changes in processes to team; collaborate with Training Coordinator on education and development.
• Participate in interdepartmental committees; support process improvements using lean methods and visual boards.

Skills

Leadership

Supervision

Coaching

Communication

Process improvement

Education

High school diploma or equivalent

Tools

Claims processing system

Microsoft Word

Excel

10-key pad

Job description

PacificSource in Oregon is seeking a Claims Supervisor to lead and coach a team of Claims Analysts, ensuring accurate processing and adherence to policy.

You will oversee production, resolve adjudication issues, hire, train, and evaluate staff, and collaborate with departments to improve processes using lean methods.

Minimum 3 years in insurance or supervisory role; high school diploma required; strong knowledge of claims systems, Word/Excel, and HIPAA/privacy compliance.