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Hospital Claims Team Leader
Imagenet LLCHospital Claims Team Leader managing a team involved in US healthcare claims adjudication. Overseeing daily claims operations and performance while providing hands-on claims adjudication expertise.
About the role
Key responsibilities & impact- Accountable for daily claims operations to meet accuracy, productivity and quality goals.
- Conduct regular weekly, monthly, and quality reviews, error trend analysis, and corrective action planning.
- Manage team performance through coaching, performance monitoring, and issue resolution.
- Develop and mentor examiners, identifying future leads and SMEs.
- Partner with training and QA teams to strengthen onboarding, refresher training, accuracy, and consistency.
- Handle client or stakeholder communication, escalations, and operational updates in a timely and professional manner.
- Provide regular business updates on team performance, quality, service levels, and improvement actions.
- Drive continuous improvement initiatives to reduce errors, delays, and rework.
- Ensure adherence to operational processes, controls, and compliance requirements.
- Collaborate with cross-functional teams such as QA, training, workforce management, HR, and client services to support execution.
- Attend and successfully complete all examiner training, certification, and nesting requirements alongside new hire examiners to develop a thorough understanding of client policies, workflows, systems, and claim adjudication processes.
- Maintain hands-on claims adjudication responsibilities including processing claims, auditing claims, and serving as the primary hospital claims subject matter expert.
Requirements
What you’ll need- At least 4 years of hands-on experience adjudicating US hospital or facility claims in a payer, TPA, or managed care setting.
- 2+ years of team leadership experience; managing a team of 10-12 Claim Examiners who are involved in adjudicating US hospital or facility claims in a payer, TPA, or managed care setting.
- Strong working knowledge of institutional billing, including UB-04 and 837I claim formats.
- Proven experience handling inpatient, outpatient, emergency room, Home Health, and SNF claims, including complex cases.
- Familiarity with payer platforms and claims adjudication systems.
- Clear and confident English communication skills, including the ability to write concise and defensible claim notes.
Benefits
Comp & perks- DAY 1 HMO Coverage + 1 Free Dependent (Medical & Dental)
- Equipment Provided – Everything you need to succeed
- Potential WFH set-up based on performance
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
claims adjudicationinstitutional billingUB-04 format837I formatinpatient claimsoutpatient claimsemergency room claimsHome Health claimsSNF claimserror trend analysis
Soft Skills
coachingperformance monitoringissue resolutionmentoringclient communicationstakeholder communicationcontinuous improvementteam leadershipcollaborationtraining
Certifications
examiner training certification