Claims Team Leader
hace 3 días
Charlotte
Job DescriptionDescription: Job Title: Claims Supervisor Job Type: FT Location: #LI- Remote, to be considered for this role, you must reside in one of the following states — AL, AK, AR, AZ, CT, DE, FL, GA, IA, ID, IN, KS, KY, LA, ME, MI, MT, MS, MO, NC, ND, NE, NH, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, WI, WV, WY Job Summary We are passionate about our clients having a great experience and this also applies to our team and our future team members. Building a remarkable team is a top-level company priority. The Claims Supervisor is responsible for overseeing the day-to-day operations of the claims processing function, ensuring timely, accurate, and compliant adjudication of all participant claims. This role leads a team of Reimbursement Specialists and is accountable for production performance, quality standards, and turnaround times. In addition to internal team leadership, this role oversees and partners with outsourced claims processing vendor, ensuring alignment to service level agreements (SLAs), quality expectations, and operational standards. The Claims Supervisor plays a key role in driving operational performance through reporting, analytics, and continuous improvement, while maintaining strict adherence to IRS and regulatory requirements. This position reports to the Customer Service Manager. What You’ll Do Team Leadership & Development • Lead, coach, and develop a team of Reimbursement Specialists, ensuring strong performance, accountability, and engagement., • Conduct regular 1:1s, team meetings, and performance reviews aligned to production, quality, and compliance expectations., • Support hiring, onboarding, and ongoing training to ensure team readiness and consistency in adjudication practices., • Oversee daily claims processing activities to ensure adherence to turnaround time (TAT) and productivity standards., • Monitor workload distribution, backlog levels, and processing queues to maintain operational efficiency., • Act as an escalation point for complex claims and adjudication decisions., • Manage and oversee outsourced claims processing vendors, ensuring alignment with internal standards and contractual SLAs., • Monitor vendor performance across quality, productivity, and turnaround time metrics., • Partner with vendors to address performance gaps, provide feedback, and drive continuous improvement., • Monitor and report on key metrics including claims TAT, accuracy, productivity, backlog, and quality scores., • Develop and deliver daily, weekly, and monthly reporting to leadership, highlighting performance trends, risks, and opportunities., • Utilize strong Excel and analytical skills to interpret data and drive informed decision-making., • Ensure all claims are adjudicated in accordance with IRS regulations, plan documents, and internal policies., • Conduct audits, identify trends, and provide targeted coaching., • Reinforce documentation standards, substantiation requirements, and fraud awareness protocols., • Identify and implement process improvements to increase efficiency, reduce rework, and enhance quality., • Partner with cross-functional teams to resolve systemic issues and improve workflows., • Support transition initiatives, including process changes, system updates, and vendor integrations., • 3–5 years of experience in claims processing or reimbursement operations, preferably within benefits administration or healthcare., • Prior experience in a supervisory or team lead role, with demonstrated ability to lead and develop teams., • Strong understanding of claims adjudication, IRS regulations, and substantiation requirements., • Experience working with or managing outsourced vendors or offshore teams., • Proven ability to manage performance against key metrics including TAT, accuracy, and productivity., • Advanced proficiency in Excel and reporting, with strong analytical and problem-solving skills., • Experience working with claims platforms and/or CRM systems (e.g., Alegeus or similar)., • Detail-oriented with a strong focus on accuracy, compliance, and process consistency., • Effective communicator with the ability to drive accountability and influence outcomes., • Ability to operate in a fast-paced environment and manage multiple priorities effectively. FloresHR’s standard work hours are Monday through Friday, 8:30 a.m. to 5 p.m. ET with an hour lunch. Roles may be approved for other schedules by managers. This role operates in a professional #LI-remote office environment. To be considered for this role, you must reside in one of the following states — AL, AK, AR, AZ, CT, DE, FL, GA, IA, ID, IN, KS, KY, LA, ME, MI, MT, MS, MO, NC, ND, NE, NH, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, WI, WV, WY. This role is mostly sedentary and consists of prolonged periods sitting at a desk and working on a computer. This role also utilizes other tools such as a phone, copy machine, and printer. Common programs often used are Outlook, Word, and Excel. This position frequently communicates with FloresHR team members and candidates and must be able to exchange accurate information clearly in these situations. How We Support Our Team At FloresHR, we invest in our people, our community and our technology and strive to provide work life balance, paired with professional growth for each of our employees. We provide an innovative benefit solution for our clients but that does not apply just to our clients. They extend to our team too! • Competitive Benefits – FloresHR offers competitive medical, dental, and vision benefits for employees and their families. We also provide company funded HSA’s, Pre- and Post-tax 401k’s with a company match up to 5%, and other great benefits such as Life Insurance, Accident Insurance, Pet insurance, and more!, • Work Life Balance – We want all our team members to have time to focus on themselves and their families. We offer a Monday - Friday schedule, a generous vacation policy and a Life Balance Reimbursement Plan to support this. Our vision is to be the most admired benefits partner, and our core values and beliefs are: • We believe in always doing the right thing., • We believe that a remarkable service experience is possible., • We believe in trusting one another as an operating philosophy., • We believe that high performance teams deliver extraordinary results., • We believe in building benefits technology that converts the complex to easy.