Claims Examiner Team Leader

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 Apply tot his job