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Job Summary

The Team Leader Claims assists supervisors, quality analysts, and managers in developing and maintaining a staff of Claims Specialists who can meet or exceed company and plan requirements by processing claims with accuracy, timeliness, and efficiency. The Team Leader also performs Claims Specialist tasks as time permits and necessity requires by answering customer-related inquires and/or processing pended claims.

Requirements

EDUCATION

High School diploma or equivalent.

EXPERIENCE

Minimum two (2) years' claims processing or customer service experience.

Demonstrates above average production, quality standards and dependability as specified by the functional area.
Detailed knowledge about all ABCBS health insurance plans and/or groups supported by the team, including expertise in benefit and claims processing guidelines preferred.

ESSENTIAL SKILLS & ABILITIES
Oral & Written Communication
Strong Interpersonal skills
Sound Judgement
Decision Making
Detail-Oriented
Teamwork
Dependability
Keyboarding
Computer Literacy
Taking Initiative
Peer Mentoring
Teamwork

Demonstrated ability to successfully assist with special requests and/or projects.

Skills

• Analyze Information • Conflict Resolution • Critical Thinking • Customer Service • Decision Making • Documentations • Evaluating Information • Interpersonal Communication • Monitor Processes, Materials, or Surroundings • Oral Communications • Problem Sensitivity • Researching • Self-Monitoring • Team Development • Time Management • Written Communication

Responsibilities

• Administration/Leadership: Ensures timely and accurate claims processing through monitoring and analysis of the workflow of Claims Specialists, handling the more difficult and sensitive situations personally and escalating issues to the supervisor as necessary.
The incumbent has the authority to make decisions within the limits of the plan documents and company policies. When unusual situations arise and the supervisor is not available, incumbent can request exceptions or a review by the appropriate authority.

In the absence of a supervisor, the Team Leader maintains a positive and productive work environment. Incumbent works closely with Claims Trainers to ensure that initial training of new employees and strength training of current team members is appropriate and consistent. May also assist the supervisor during the interview process for new employees • Mentoring/Relationship Building: Mentors team members to ensure their understanding of work-related duties and provides detailed assistance with work related functions as needed. Provides effective feedback and coaching regarding performance and quality standards. The incumbent also works to foster a culture of teamwork and develops and maintains good working relationships with management and staff in other departments that support the Claims team • Other duties: As assigned • Problem Solving: Constantly analyzes the claims workflow in order to recognize trends that may need further attention. Working closely with the Claims Specialists, the incumbent reviews processes, identifies the need for training and development, gives feedback to enhance the workflow of individual team members, monitors claims for accuracy and timely process, and answers customer-related inquires as necessary

Certifications

Hiring Range

$25.99 - $31.28

 

Security Requirements

This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual.

Segregation of Duties

Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual.

Employment Type

Regular

ADA Requirements

1.1 General Office Worker, Sedentary, Campus Travel - Someone who normally works in an office setting or remotely and routinely travels for work within walking distance of location of primary work assignment.