Claims Team Lead

Health Admins

Claims Team Lead overseeing claims processing operations and leading a team in healthcare administration. Driving continuous improvements while ensuring timely and accurate handling of member claims.

Posted 7/23/2026full-timeAustin • Texas • 🇺🇸 United StatesSeniorWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in claims processing, team leadership, and process improvement within the healthcare sector. Proficient in managing escalated issues, ensuring compliance, and enhancing operational efficiency through effective communication and collaboration.

Highest-signal resume keywords

Claims ProcessingTeam LeadershipProcess ImprovementMedical TerminologyCRM Systems

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ProcessingMedical BillingData EntryProcess ImprovementKPI Tracking

Soft Skills

Critical ThinkingProblem-SolvingAttention to DetailCommunicationEmpathy

Tools & Technologies

CRM SystemsSalesforce

Industry Keywords

HealthcareClaims ProcessingMedical TerminologyEscalated IssuesCompliance

About the role

Key responsibilities & impact

Lead a team of 4-7 Claims Processors and Senior Claims Processors, providing ongoing support, answering questions, and offering guidance in handling complex or escalated cases.
Oversee daily claims processing tasks, ensuring timely and accurate handling of member claims, reviewing medical invoices, and processing payments in alignment with company guidelines and deadlines.
Serve as the primary point of contact for escalated issues, working closely with members and providers to resolve disputes or sensitive cases.
Assist in training new and junior staff members, providing coaching and feedback to help them grow and improve their performance.
Work closely with Management to monitor department performance, track KPIs, and implement process improvements as needed.
Coordinate with various departments to enhance the claims processing experience for members and ensure a seamless workflow.
Identify inefficiencies within the team and recommend automation, system enhancements, or procedural changes to optimize claims processing.
Ensure compliance with internal and external policies by maintaining accurate member records in the CRM system and conducting periodic audits of claims processed by the team.
Handle direct communication with members, ensuring queries and escalations are managed with professionalism, empathy, and accuracy.

Requirements

What you’ll need

Bachelor's degree or equivalent experience in a related field
2-3 years of experience in healthcare, claims processing, or a related field, including 1-2 years of leadership experience
Experience in process improvement, team management, or case management is preferred.
Experience with CRM systems, such as Salesforce, is a plus.
Advanced knowledge of medical terminology, claims processing, and medical billing practices.
Proficiency in working both independently and collaboratively within a fast-paced, team environment.
High level of attention to detail, accuracy in documentation, and data entry.
Critical thinking and problem-solving skills, especially when resolving escalated issues.
Ability to multitask and adapt to changing priorities efficiently.

Benefits

Comp & perks

Competitive salary and benefits package
Dynamic and innovative work environment
Opportunities for professional growth and development
Remote work flexibility