Team Leader - Claims-Elite/Commercial
A working team leader responsible for managing all aspects of the day-to-day operations of claims production
and COB investigation. Responsible for staff selection and supervision. Responsible for pend reduction
strategies. Directs and implements procedures that assure accurate and prompt payment of claims. Ensures all
incoming and outgoing correspondence is accurate, timely, and appropriate for audience. Act as a liaison
between all units within Claims. Resolve escalated claim or provider issues initiated by internal and/or
external customers. Motivate and develop team goals to ensure processing is done timely in order to meet
contractual and governmental regulations for the Plan. Senior claim adjudicators, claim adjudicators, and COB
coordinators report directly to this position.
- Associates Degree required. Bachelor's Degree strongly preferred.
- Minimum 3-5 years' experience in batch, on-line, electronic, dental, and vision claims processing
- with multiple lines of HMO, PPO or related insurance business strongly preferred.
- Demonstrated experience in properly conducting job applicant interviews and selection.
- Demonstrated ability to turn ‘vision’ into actual action plans.
- Work independently, under tight time deadlines, handles pressure situations and shift priorities
- Knowledge of medical terminology, ICD, CPT, and DRG coding with a good working knowledge
- of State of Ohio & - Michigan compliance regulations required.</li>
- Supervisory/managerial experience in a day-to day fast paced productivity environment required.
- Excellent written, verbal & interpersonal communication skills required.</li>
- Demonstrated ability to work independently and plan/coordinate/organize multiple priorities.
- Demonstrated ability of word processing (Microsoft Word and Excel) skills required.
- Ability to communicate on telephones and move between company work stations/departments.
- Demonstrated working ability with imaging/workflow systems required
- Maintain a high level of motivation, initiative, and accountability.
- Handle conflict in a productive manner.
ProMedica is a mission-based, not-for-profit health and well-being organization headquartered in Toledo, Ohio. It serves communities in 28 states. The organization offers acute and ambulatory care, an insurance company with a dental plan, and post-acute and academic business lines. The organization has more than 49,000 employees, 13 hospitals, 2,500+ physicians and advanced practice providers with privileges, 1,000+ healthcare providers employed by ProMedica Physicians, a health plan, and 330+ assisted living facilities, skilled nursing and rehabilitation centers, memory care communities, and hospice and home health care agencies. Driven by its Mission to improve your health and well-being, ProMedica has been nationally recognized for its advocacy programs and efforts to address social determinants of health. For more information about ProMedica, please visit www.promedica.org/aboutus.
Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex, pregnancy, sexual orientation, gender identity or gender expression, age, disability, military or veteran status, height, weight, familial or marital status, or genetics.
Equal Opportunity Employer/Drug-Free Workplace
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