Job Description:
• Responsible for leading and managing a team of claims examiners to ensure accurate, compliant, and timely processing of medical claims.
• Serve as a critical bridge between frontline operations and leadership.
• Drive performance against SLAs, quality standards, and productivity targets.
• Accountable for team performance, coaching and development, and continuous process improvement.
• Ensure adherence to Medicare regulations and CMS guidelines.
• Oversee day-to-day medical claims processing for professional, facility, adjustments, corrected and adjustment claims.
• Ensure compliance with Medicare requirements, CMS guidelines, client policies, and Imagenet standards.
• Monitor and manage service level agreements (SLAs), turnaround times, and production.
• Review claims and audit results to identify trends, root causes, and training opportunities.
• Prepare and present operational and business reviews using accurate data and client feedback.
• Identify operational risks, performance gaps, and improvement opportunities and escalate as appropriate.
• Recognize and reward strong performance and team achievements.
Requirements:
• Min. 5 years of experience processing easy, moderate, and complex medical claims.
• 2+ years in a leadership role within claims or healthcare operations.
• Strong experience with Medicare and Medi-Cal claims, including a working knowledge of CMS guidelines and regulatory requirements.
• Prior quality assurance and training experience with demonstrated ability to identify trends.
• Previous experience leading, coaching, or mentoring teams in a claims or healthcare operations environment.
• Strong analytical skills with the ability to interpret performance data and KPIs.
• Excellent communication, organizational, and decision-making skills.
• High attention to detail and commitment to accuracy, compliance, and operational excellence.
Benefits:
• Remote work offered
• Equipment provided
• Paid training to set you up for success
• Comprehensive benefits: Medical, Dental, Vision, Life, HSA, 401(k)
• Paid Time Off (PTO)
• 7 paid holidays
• A supportive team and a company that values internal growth
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