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Imagenet · 1 month ago

Claims Examiner Team Leader | Remote

United States

Full-time

Remote

Senior Level

$22/hr - $22/hr

5+ years exp

Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. The Claims Examiner Team Leader is responsible for leading a team of claims examiners to ensure accurate and timely processing of medical claims while driving performance against quality standards and compliance with regulations.

Information Technology

Responsibilities

Lead, supervise, and support a team of 15–20+ claims examiners

Provide ongoing coaching, mentoring, and real-time feedback to improve quality, accuracy, and productivity

Conduct regular performance evaluations and goal setting

Foster a culture of accountability, engagement, integrity, and continuous improvement

Oversee day-to-day medical claims processing for professional, facility, adjustments, corrected and adjustment claims

Ensure compliance with Medicare requirements, CMS guidelines, client policies, and Imagenet standards

Monitor and manage service level agreements (SLAs), turnaround times, and production

Apply deep working knowledge of CMS regulations, Medicare auditing standards, and payer guidelines

Review claims and audit results to identify trends, root causes, and training opportunities

Ensure consistent application of quality standards by partnering with other team leads to reduce error rates across the team

Analyze and manage key performance indicators including quality scores, error rates, productivity, attendance, and rework

Prepare and present operational and business reviews using accurate data and client feedback

Identify operational risks, performance gaps, and improvement opportunities and escalate as appropriate

Identify process inefficiencies and implement improvement strategies to increase accuracy, efficiency, and cost effectiveness

Assist with QA, Training, IT, and Operations leadership to resolve technical or workflow issues

Support implementation of new policies, tools, workflows, and client requirements

Maintain clear, timely communication with leadership regarding team performance and operational risks

Address employee concerns and team conflicts professionally and promptly

Escalate client issues or compliance concerns to management immediately when identified

Recognize and reward strong performance and team achievements

Promote teamwork, professionalism, and a positive attitude within the team

Qualification

Medical claims processingLeadership in healthcare operationsMedicareMedi-Cal knowledgeQuality assurance experienceAnalytical skillsCommunication skillsOrganizational skillsDecision-making skillsAttention to detail