The Claims Specialist Lead is responsible for assisting the Claims Manager and Claims Staff with claim issues. The positions assist the Claims Manager with workload assignments as needed, filling in for staff as needed, and troubleshooting questions in the absence of the Claims Manager. Complies with governmental and managed care rules and regulations. Meets department goals as well as productivity and quality standards.
Responsibilities and Essential Job Functions
Assists in coordinating the team’s workload.
Works closely with team members on problem solving, training and mentoring.
Acts as subject matter expert in absence of the department manager to both internal and external customers.
Observes and communicates to the Claims manager trends with claims processing by insurance companies or technical issues with the claims clearing house.
Confirms receipt of daily billing files by the claims clearing house.
Researches and resolves any claim rejections within designated timeframes.
Reports any claim rejection trends or delays to management.
Submits paper claims and supporting documentation as required by payers.
Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department.
These statements are intended to describe the essential functions of the job and are not intended to be an exhaustive list of all responsibilities. Skills and duties may vary dependent upon your department or unit. Other duties may be assigned as required.
Required Education and Experience
High School Graduate or GED.
3 or more years of experience in claims, or insurance processing.
Preferred Education and Experience
Associates Degree in a related field of study from an accredited college or university.
4 or more years of Epic experience.
Time Type:
Full time
Job Requisition ID:
R-58518
Important information for you to know as you apply:
The health system is an equal employment opportunity employer. Qualified applicants are considered for employment without regard to race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, ancestry, age, disability, veteran status, genetic information, or any other legally-protected status. See also Diversity, Equity & Inclusion.
The health system provides reasonable accommodations to qualified individuals with disabilities. If you need to request reasonable accommodations for your disability as you navigate the recruitment process, please let our recruiters know by requesting an Accommodation Request form using this link