Senior Team Lead, Claims Operational Support Teams

Our Research and Resolution teams are part of our largest and core teams within Health Plan operations, performing the specialized back office work required to operate our employer-sponsored medical plans and run the core processes that power our business. This team oversees complex workflows and works frequently with internal and external teams. As such, you should have a knack for (and experience with) collaborating cross-functionally and representing Collective Health externally, as well as helping your direct reports do the same.

Our Research & Resolution Associates perform a variety of work with a comprehensive understanding of health plan operations—ensuring medical claims are paid promptly, researching complicated member issues, and handling the complex details related to medical network integrations, regulatory requirements, and medical coding. Beyond becoming experts in these areas, our team also strives to make health benefits effortless for our clients, our members, and ourselves.

We are hiring a Senior Team Lead to help manage our growing Member Claims team. Additionally, you will help us to build our team, define our culture, coach team members, and provide regular feedback to ensure we are delivering on the high accuracy and efficiency standards we set for ourselves and our work. You will also work cross-functionally, contributing to our goals and helping us build our business. You will report to the Senior Manager, Member Claims.

What you'll do:

• Team Leadership:
  • Build, lead and develop a high performing team, fostering a positive and collaborative work environment.
  • Provide ongoing coaching, training, and feedback to team members to enhance their skills and performance.
  • Set performance goals and conduct regular performance reviews to drive continuous improvement.
• Claims Processing Oversight:
  • Ensure timely and accurate processing of claims in adherence to established guidelines and standards.
  • Monitor workflow to identify and address bottlenecks or issues that may impact efficiency.
  • Collaborate with other departments to streamline processes and improve overall claims processing.
• Quality Assurance:
  • Implement and maintain quality assurance measures to guarantee the accuracy and consistency of claims processing.
  • Conduct regular reviews and provide constructive feedback to team members to uphold quality standards.
• Department-wide Responsibilities:
  • Take the lead on department-wide projects, demonstrating the ability to plan, execute, and complete projects with minimal oversight.
  • Collaborate with cross-functional teams and stakeholders to ensure project success and alignment with organizational goals.
  • Develop strong operational relationships and drive process improvement efforts with Collective Health’s medical network partners.
  • Partner with Member Services & Claims Ops Leadership and drive towards strategic process improvements and industry best practices across the MCA department.
  • Work cross-functionally with multiple Collective Health teams such as PM&D, Eligibility, Product, Product Ops, Legal, Member Claims, Member Advocates, WFO, Client Success, and Analytics to monitor overall operational health.
• Performance Analysis and Reporting:
  • Generate and analyze reports to track team and individual performance metrics.
  • Identify trends, areas for improvement, and opportunities for innovation in claims processing.
  • Meet aggressive performance goals...driving performance, effectiveness and efficiencies across your team’s central domains.
• Continuous Improvement:
  • Proactively identify process improvements and work with the team to implement changes that enhance efficiency and accuracy.
  • Help the team scale external communication pathways to make them more efficient, and effective.
• Supporting Newer Team Leads:
  • Provide mentorship and guidance to newer team leads to facilitate their integration into leadership roles.