Claims Team Lead - REMOTE

Job Description

Job Description

S&S Health is a premier healthcare administration company based in Cincinnati, Ohio. We specialize in offering self, level, and fully funded solutions designed to lower costs and enhance outcomes while providing a consumer-centric experience. Our comprehensive benefits, services, and technology platform are tailored to meet the needs of Employers, TPAs, and Health Systems. With a nationwide presence, S&S Health is equipped to sell and service clients across every state.

The Claims Team Lead is responsible for the accurate and timely processing of medical claims and related correspondence. This role requires a high level of attention to detail, precision, and thoroughness. The Senior Claim Processor will work both independently and collaboratively to adjudicate claims and address provider or client inquiries professionally and promptly. In addition to processing claims, this role includes supporting managerial functions, resolving complex issues, and contributing to process improvements and employee training.

Key Responsibilities

• Claims Processing: Accurately and promptly process claims and related correspondence across all lines of business, including complex claims. Review claims for appropriate prior authorization/pre-certification of services, required information, and request additional details as needed.
• Ticket and Correspondence Management: Assist the manager by assigning tickets and correspondence to ensure efficient workflow and timely resolution.
• Customer Service and Escalations: Respond to employee questions and resolve escalated or complex issues effectively, providing high-quality support and maintaining professionalism.
• Process Improvement and Training: Support the training of new employees and new processes. Share best practices with processors to ensure timely and accurate processing of claims. Identify opportunities for process improvement and collaborate on implementing enhancements.
• Adjustment Handling: Handle adjustments and inquiries from Customer Service in a timely manner.
• Invoice Processing: Process third-party invoices efficiently.
• Multi-tasking and Deadlines: Multi-task effectively and consistently meet deadlines, adhering to and maintaining established quality and production standards.
• Collaboration and Communication: Work independently and cooperatively with other team members. Maintain excellent verbal and written communication skills to facilitate effective interactions.
• Performance Metrics: Meet and maintain established performance metrics set by our customers.
  
  

Qualifications

• Minimum 5 years of experience as a claim processor, with a track record of meeting/exceeding quality and production goals.
• Commitment to adhering to established quality and production standards.
• Willingness to support and contribute to team goals and company objectives.
• Knowledge of medical terminology, HIPAA, standard claims forms (HCFA and UB), and physician billing coding.
• Ability to read and interpret contracts and standard reference materials (PDR, CPT, ICD-9, ICD-10, and HCPCS).
• Knowledge of Coordination of Benefits (COB).
• Proficiency in Microsoft Word, Excel, and Outlook.
• High level of self-motivation, productivity, attention to detail, and organizational skills.
• Excellent verbal and written communication skills.
  
  

We are committed to creating a safe and secure workplace for all employees. Please note that all final candidates will be subject to a comprehensive background check and drug testing as part of our hiring process.