Job Summary:
The Team Lead, Claims Performance Solutions directs day-to-day staff activities to ensure service and performance objectives are met.
Essential Functions:
- Responsible for day-to-day activities surrounding the knowledge and insight around development and support of process enhancements, process automation, and data analytics
- Provide leadership and direction to staff to ensure daily operational functions and goals are being met
- Responsible for onboarding, training, performance feedback, and development of staff
- Prioritize all work, requests and activities, and escalate any area of significant resource contention with recommendation for resolution
- Track issues and status to ensure proper follow-up, coordination with business area and provide solutions
- Update project that Claims Performance Solutions is involved with and coordinate any needed changes with manager
- Provide management with ticket dashboards. Identify root cause of issues and appropriate proactive resolution to reduce tickets in the future
- Identify systemic opportunities for root cause analysis and continuous improvement
- Manage and maintain reporting dashboards for inventory and root cause identification
- Recognize and proactively manage scope and expected benefits across claims strategic initiatives and process improvements and is a key contributor to the claims technical advancements
- Ensure Claims Performance Solutions team members identify, escalate and/or resolve complex or non-routine questions, issues, and problems within SLA timelines and provide direction as needed and/or escalate to senior management as appropriate
- Manage team workflow technical solutions, processes, and procedures
- Oversight of documenting process development and improvements, testing, and promotion of changes to promote consistency in department operations following established departmental change management processes
- Create reports and pull claims data to identify trends or significant variation from expectation to resolve tickets and initiatives
- Maintain positive and strategic relationships with internal and external stakeholders
- Perform any other job-related instructions, as requested
Education and Experience:
- Bachelor Degree or equivalent years of relevant work experience is required
- Minimum of three (3) years of experience in data analysis required
- Minimum of three (3) years programming experience or equivalent education required
- Training in statistical process control methodology preferred
- Healthcare delivery and/or payer experience preferred
- Proven ability to lead work efforts within a department setting with or without staff reporting responsibility
Competencies, Knowledge and Skills:
- Proven understanding of database relationships required
- Graphic development/presentation skills strongly preferred
- Advanced computer skills
- Critical listening and thinking skills
- Decision making/problem solving skills
- Communication skills both written and verbal
- Ability to work independently and within a team environment
- Knowledge of managed care preferred
- Time management skills; capable of multi-tasking and prioritizing work
- Effective decision making / problem solving skills
- Knowledge of regulatory reporting and compliance requirements
- Excellent listening and critical thinking skills
- Proficiency in Microsoft Suite to include Word, Excel and Access
- Computer skills and abilities in Facets or equivalent claims adjudication system
- Ability to identify and recommend process improvements
- Ability to effectively interact with all levels of the organization
Licensure and Certification:
Working Conditions:
- General office environment; may be required to sit or stand for extended periods of time
Compensation Range:
$81,400.00 - $130,200.00
CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.
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