Team Lead, Claims Performance Solutions

Job Summary:

The Team Lead, Claims Performance Solutions directs day-to-day staff activities to ensure service and performance objectives are met.

Essential Functions:

• Responsible for day-to-day activities surrounding the knowledge and insight around development and support of process enhancements, process automation, and data analytics
• Provide leadership and direction to staff to ensure daily operational functions and goals are being met 
• Responsible for onboarding, training, performance feedback, and development of staff
• Prioritize all work, requests and activities, and escalate any area of significant resource contention with recommendation for resolution
• Track issues and status to ensure proper follow-up, coordination with business area and provide solutions
• Update project that Claims Performance Solutions is involved with and coordinate any needed changes with manager
• Provide management with ticket dashboards.  Identify root cause of issues and appropriate proactive resolution to reduce tickets in the future
• Identify systemic opportunities for root cause analysis and continuous improvement
• Manage and maintain reporting dashboards for inventory and root cause identification
• Recognize and proactively manage scope and expected benefits across claims strategic initiatives and process improvements and is a key contributor to the claims technical advancements
• Ensure Claims Performance Solutions team members identify, escalate and/or resolve complex or non-routine questions, issues, and problems within SLA timelines and provide direction as needed and/or escalate to senior management as appropriate
• Manage team workflow technical solutions, processes, and procedures
• Oversight of documenting process development and improvements, testing, and promotion of changes to promote consistency in department operations following established departmental change management processes
• Create reports and pull claims data to identify trends or significant variation from expectation to resolve tickets and initiatives
• Maintain positive and strategic relationships with internal and external stakeholders
• Perform any other job-related instructions, as requested

Education and Experience:

• Bachelor Degree or equivalent years of relevant work experience is required
• Minimum of three (3) years of experience in data analysis required
• Minimum of three (3) years programming experience or equivalent education required
• Training in statistical process control methodology preferred
• Healthcare delivery and/or payer experience preferred
• Proven ability to lead work efforts within a department setting with or without staff reporting responsibility

Competencies, Knowledge and Skills:

• Proven understanding of database relationships required
• Graphic development/presentation skills strongly preferred
• Advanced computer skills
• Critical listening and thinking skills
• Decision making/problem solving skills
• Communication skills both written and verbal
• Ability to work independently and within a team environment
• Knowledge of managed care preferred
• Time management skills; capable of multi-tasking and prioritizing work
• Effective decision making / problem solving skills
• Knowledge of regulatory reporting and compliance requirements
• Excellent listening and critical thinking skills
• Proficiency in Microsoft Suite to include Word, Excel and Access
• Computer skills and abilities in Facets or equivalent claims adjudication system
• Ability to identify and recommend process improvements
• Ability to effectively interact with all levels of the organization

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

$81,400.00 - $130,200.00

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Salary

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships