Claims Examiner Team Leader

Job Summary

Leading a team of claims examiners, the full-time remote Claims Examiner Team Leader will ensure accurate and compliant processing of medical claims while driving performance, coaching team members, and implementing continuous process improvements.

Key Responsibilities

• Supervise and support a team of 15-20+ claims examiners, providing coaching and performance evaluations
• Oversee daily medical claims processing, ensuring compliance with Medicare and CMS guidelines
• Analyze key performance indicators and present operational reviews to identify improvement opportunities

Required Qualifications

• Minimum of 5 years of experience processing medical claims, including complex cases
• At least 2 years in a leadership role within claims or healthcare operations
• Strong knowledge of Medicare and Medi-Cal claims, along with CMS regulatory requirements
• Experience in quality assurance and training with the ability to identify trends
• Proficient analytical skills to interpret performance data and KPIs