Claims Team Lead

Posted 4 months ago

Position Title: Claims Team Lead

Reports To: NE Region Operations Manager

Position Summary:

We are adding the Claims Team Lead to support the company’s continued growth.  The position will support the NE Region Operations Manager with all activities related to our claim solutions.  This includes but is not limited to assisting with claims operations for assigned clients, owning the insurance master, and helping with the management of our clearinghouse vendor.  

Please understand that we intend to find someone who has the right attitude, fits our culture, and will learn our business.  They need to be willing to work in the details and process transactions while the company grows with the understanding that expansion will provide meaningful career opportunities.

Position Location: West Palm Beach Office or Remote, with office preferred

Essential Duties and Responsibilities:

  • Assist with claim operations for assigned clients:
    • Process claim filing and add insurance transactions, meeting or exceeding production and quality goals.
    • Ensure operational quality and productivity.
    • Create and monitor operational critical performance indicators (KPIs), taking action when appropriate.
    • Set, monitor, and ensure achievement of goals.
  • Own the insurance master:
    • Ensure entries are complete for all coverage types and states, with no duplicates.  
    • Create and maintain the default submission type and the corresponding clearinghouse IDs with a preference for EDI, then fax, and lastly mail.
    • Maintain the insurance master via periodic clearinghouse payer updates.
  • Assist with the management of our clearinghouse vendor:
    • Ensure productivity and quality.
    • Lead the identification and resolution of issues.
    • Lead the identification and implementation of initiatives.
  • Assist with the creation and maintenance of claim standard operating procedures (SOPs).
  • Participate in professional/company development activities.
  • Promptly answer client questions.
  • Assist with people, process, and technology issue resolution.
  • Identify and participate in initiatives that improve client satisfaction, increase collections, increase patient satisfaction, and/or enhance compliance.
  • Develop and maintain an understanding of state ARC RCM regulations, people, processes, and systems.
  • Know and follow information systems security policies and procedures, attend security training when offered, and report information systems security problems.
  • Adhere to and enforce compliance and company policies and procedures.

Additional Expectations: 

  • Assist all company departments as requested by company leadership.  
  • Develop and sustain excellent working relationships with internal and external professionals as well as with the Company’s clients, payers, consultants, banks and financial intermediaries and government agencies.
  • Convey an attitude of intolerance for unprofessional behavior.
  • Promote an environment of mutual respect, courtesy, and value of others’ opinions/ideas. 
  • Use initiative to learn new skills, enhance personal knowledge, and improve communications.
  • Occasionally be available after standard work hours to resolve client needs.

Candidate Qualifications & Expertise:

  • Experience with healthcare RCM.
  • Strong analytical and problem-solving skills.
  • Excellent organization and time management capabilities.
  • Strong Microsoft office skills, in particular Word and Excel.
  • Exceptional interpersonal skills with the ability to communicate at all levels.
  • Highly self-motivated and directed.
  • Maintains an intense execution focus and demands results.
  • Effectively copes with change, comfortably handling risks and uncertainty.
  • Conveys a sense of passion for quality and excellence, fostering continuous improvement.
  • Committed to transparency of information.
  • Embodies the company’s values.

Our Values:

  • Delight Our Customers – We exceed our clients’ expectations and believe that in doing so the company will grow and our teammates will have a positive work experience. 
  • Bring Innovative Solutions – We provide creative solutions and do so via a collaborative approach where everyone is encouraged to contribute ideas.
  • Pay Attention to Details – We put a premium on quality and believe that details are what sets us apart from the competition.
  • Think Straight, Talk Straight – We speak directly with one another, have a high level of integrity, and are inclusive in setting goals and solving problems.  
  • Get “Stuff” Done – We set titles aside and are committed to diving in, regardless of the perceived task level or area of responsibility, in order to get things done.  
  • Have Fun – We make a conscious effort to have fun and bring a positive attitude to work every day.  

Come work for a rapidly growing company in the healthcare industry.  For additional company information please go to our website at go-sb.com.