Claims Examiner Team Leader

Imagenet LLC

Claims Examiner Team Leader responsible for supervising claims processing teams and ensuring compliance in a remote setting. Focused on performance metrics and quality standards as part of Imagenet's healthcare operations.

Posted 7/8/2026full-timeRemote • Florida • 🇺🇸 United StatesSenior💰 $22 per hourWebsite

Core Competencies

Role fit

Core Competencies

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

Demonstrates expertise in managing medical claims processing while ensuring compliance with Medicare regulations and CMS guidelines. Proven ability to lead teams, drive performance, and analyze key performance indicators to enhance operational efficiency.

Highest-signal resume keywords

Medical Claims ProcessingLeadership in Healthcare OperationsCMS Guidelines KnowledgeAnalytical SkillsQuality Assurance Experience

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Claims ExaminationPerformance Data AnalysisRegulatory ComplianceProcess ImprovementKPI ManagementTraining and DevelopmentError Rate AnalysisOperational Risk IdentificationSLA MonitoringMedicare Auditing Standards

Soft Skills

Communication SkillsOrganizational SkillsDecision-Making SkillsAttention to DetailCoaching and Mentoring

Industry Keywords

MedicareMedi-CalClaims OperationsHealthcare CompliancePerformance Standards

About the role

Key responsibilities & impact

Responsible for leading and managing a team of claims examiners
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
Accountability for team performance, coaching and development, and process improvement
Ensure adherence to Medicare regulations and CMS guidelines
Oversee day-to-day medical claims processing
Monitor and manage service level agreements (SLAs), turnaround times, and production
Apply deep working knowledge of CMS regulations, Medicare auditing standards, and payer guidelines
Review claims and audit results to identify trends and training opportunities
Analyze and manage key performance indicators including quality scores, error rates, productivity, and attendance
Prepare and present operational and business reviews
Identify operational risks, performance gaps, and improvement opportunities

Requirements

What you’ll need

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

Comp & perks

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