Claims Team Lead II

Overview

HealthEdge ® offers AI-powered operational infrastructure for health insurance companies, guaranteeing an enduring financial edge in an increasingly competitive market. We're experiencing strong market momentum, with a growing number of health plans choosing HealthEdge to modernize their operations and compete more effectively. As we expand, we're investing in the people who power that growth, making this a pivotal moment to join us and shape the future of healthcare technology. Learn more at HealthEdge .com.

At UST HealthProof, you will join a fast paced, growing company in our mission to reshape the future of health insurance through significantly reducing administrative costs and building better healthcare experiences for our health plans customers and their members. By creating a modern, cloud based, Best-In-Class core administration ecosystem, we have made healthcare more affordable and helped our health plans operate more efficiently. Through member and provider touchpoints with less friction, we have created real impact for members.

UST HealthProof is run by leaders with strong health plan and technology backgrounds who have start-up mindsets and an environment of support where individual growth is nurtured. You will be supporting our proven core admin solutions and business process-as-a-service (BPaaS) operations to provide transparency, improve operational efficiency, and break down operational barriers to scale and drive strategic growth.

UST HealthProof is looking for Claims Team Lead, reporting to the Claims Manager. The Claims Team Lead is responsible for a team of typically 12-15 claims examiners, adjusters, extensive interaction with client organization, and multiple stakeholders. The Claims Team Lead is accountable for delivering a high-quality claims operation, meeting and exceeding all service level agreements and KPIs, driving operational excellence, and building competencies for delivery.

As a Claims Team Lead at UST HealthProof, this is your opportunity to

- Be responsible for directly managing a staff of typically 12 - 15 associates

- Be responsible for knowing and meeting client-specified guidelines

- Be responsible for monitoring and management of the downline staff’s productivity targets and financial and procedural accuracy standards as established by management

- Collaborate on special projects as assigned by the manager; special projects can include process documentation development, training, quality audits, assisting with surge activity for the client(s), or any other project as determined by management

- Establish and maintain an appropriate level of communication with management to address issues and concerns and take preventive measures that ensure processing accuracy and quality

- Assemble and assign projects that may include provider data, authorizations, enrolment, or other information

- Perform other duties as assigned by your leadership

You bring:

- 5+ years healthcare claims processing experience HRP

- Solid understanding and ability to effectively lead a claims team

- Good communication skills (verbal and written)

- Microsoft application experience, especially Excel is suggested

- ICD-10 CPT and HCPCS coding is a plus

- Knowledge base of physician billing and hospital coding (ICD-10, HCPC, CPT-4), medical terminology, and authorization requirements

- Willingness to learn new skills

- Team collaborator

- Strong work ethic

For this role, we value:

- The ability to adapt quickly to a fast-paced environment

- A self-starter and quick learner

- Team player with an ability to collaborate

- Ability to coach the team to reach their full potential

- Dependability and the ability to work independently

Geographic Responsibility: Remote, US

Type of Employment: Full-time, permanent

Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions