Team Lead – Adjustment and Recovery

Team Lead – Adjustment and Recovery

Requirements

• Claim adjustments experience.
• 2+ years medical claims processing experience.
• Excellent verbal and written communication skills.
• Independent decision-making skill.
• Effective organizational and interpersonal skills.
• Demonstrated ability to handle multiple assignments competently, accurately, and efficiently.

Responsibilities

• Responsible for researching complex tasks and solutioning encountered system issues; maintaining and managing automating adjustment programs/processes; providing support to leadership to meet business KPI’s; conducting user acceptance testing (UAT).
• Perform associated team lead duties to maintain and meet business performances.
• Manage work inventory; provide training on work tasks; mentor and be the subject matter expert (SME) to team members.
• Support leadership, assist in strategic planning and overall work completion to meet established KPI’s.
• Collaboratively develop training materials; perform training to new hires or internal cross-trainings.
• Facilitate meetings to staff and/or other departments; provide updates/clarifications for accurate completion of work tasks.
• Mentor and provide guidance on adjustments, posting of refunds, and/or recovery to team members; review and direct resources to ensure accuracy.
• Distribute urgent/escalated work assignments daily to staff.
• Use analytical and statistical techniques and tools to plan and perform research and analysis of processes (e.g., outcomes performance guarantees, government regulations, and customer requirements, etc.) to recommend enhancements and workable solutions.
• In partnership with business owners, support the design and development of new processes.
• Participate in the development and validation of master or detail UAT test plans and strategies.
• Develop and design data collection capability (e.g., recovery, work inventory)
• Lead working sessions to develop processes and/or resolve issues, including create enhancements and process efficiency.
• Support the creation of communication strategies and presentations for both internal and external customers to educate and address continuous improvement initiatives.
• Analyze and resolve complex adjustment scenarios within established time frames.
• May, under supervision, develop quality assessment/measurement programs tailored to specific assignments.
• Analyze customer feedback and other measures.

Preferred Qualifications

• Experience working on project teams
• Experience conducting user acceptance testing (UAT)
• DG claims system experience