Claims Specialist Lead

The Claims Specialist Lead is responsible for assisting the Claims Manager and Claims Staff with claim issues. The positions assist the Claims Manager with workload assignments as needed, filling in for staff as needed, and troubleshooting questions in the absence of the Claims Manager. Complies with governmental and managed care rules and regulations. Meets department goals as well as productivity and quality standards.

Responsibilities

Assists in coordinating the team's workload; Works closely with team members on problem solving, training and mentoring; Acts as subject matter expert in absence of the department manager to both internal and external customers; Observes and communicates to the Claims manager trends with claims processing by insurance companies or technical issues with the claims clearing house; Confirms receipt of daily billing files by the claims clearing house; Researches and resolves any claim rejections within designated timeframes; Reports any claim rejection trends or delays to management; Submits paper claims and supporting documentation as required by payers; Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department

Requirements

High School Graduate or GED; 3 or more years of experience in claims, or insurance processing

Nice to have

Associates Degree in a related field of study from an accredited college or university; 4 or more years of Epic experience