Job Summary
The Assistant Claims Team Lead is responsible for managing a team of Claims Examiners for the day-to-day operations of claims.

Essential Functions

The essential functions listed represent the major duties of this role, additional duties may be assigned.

Managing Claims Examiners:

• Serve as SME and primary point of contact with all claims processing related questions
• Directly accountable for hiring new employees which includes partnering with Talent Acquisition team, conducting interviews, feedback and approvals. Manages Onboarding plan for new hires, coordinates with Talent Development training plans, check-ins and progress reports.
• Manage and review claims, open notes, and checks backlog on a daily basis. Assess and assign claims processing prioritization, make adjustments when necessary to ensure deadlines and performance guarantees are being met.
• Review established metrics for quality and accuracy of claims processed. Partner with Internal Audit and Auditors in assessing metrics and areas of concern or improvement.
• Coach employees on performance. Checks in with employees on a regular basis via 1:1 meetings. Makes recommendations to Claims Examiners and to Sr. Management for areas of opportunity. Conducts performance appraisals.
• Reward and recognize team members for successfully performing goals and objectives and fosters a team environment upholding company mission, vision, values.
• Partners with HR on issuing any disciplinary issues and terminations complying with established processes and procedures to ensure compliance and fairness.
• Serve as Time Keeper reviewing time cards. Submits requests for OT to Sr. Manager & Leadership for approval. Reviews and approves or denies PTO request based on needs of business.

Claims Processing, Testing, and Benefits Changes Administration:

• Process claims at the highest dollar threshold and review more complex items.
• Investigate claims in question by members or clients.
• Assist Manager with call backs for members and providers
• Communicate directly with both clients and internal teams to resolve any issues or concerns.
• Complete claim testing for benefit changes, renewals, and new groups.
• Review claim benefits issues with IT/Plan Build.
• Update and create benefit grids as necessary.
• Assist SilverSkills with any claim questions or audits.

Required Work Experience

• 2+ years related work experience
  • Claims Examiner/adjudication experience on a computerized claims payment system in the healthcare industry.

• 1+ years direct supervisory/management experience
• Must possess proven judgment, decision-making skills and the ability think analytically.
• Must learn quickly as well as be able to multi-task.
• Concise written and oral communication skills required, including the ability to deal with conflict.
• Experience in processing all types of medical claims.
• Must be motivated as well as possess a sound work ethic.
• Ability to maintain good rapport with cliens, providers and internal employees.
• Excellent written and verbal communication.
• Knowledge of all MS Office products.
• Proficiency and experience in iii:PUT.
• Customized programs for medical CPT coding, review of multiple surgical procedures, and establishment of reasonable and customary fees.

Required Education

• Related Bachelor’s degree or additional related equivalent work experience

Preferred Qualifications

• 1+ year WebTPA specific claims processing experience preferred.

General Physical Demands

• Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

Physical/Environmental Activities

• Must be able to travel to multiple locations for work (i.e. travel to attend meetings, events, conferences). Occasionally