Curative

Curative is searching for a Claims Analyst Team Lead to assist with leading our claims department. This role is centered around assisting in the leadership of a team of claims processors, ensuring the accuracy and efficiency of claims submissions, and driving improvements in the overall performance of claims operations. The ideal candidate will demonstrate strong leadership abilities, possess extensive knowledge of medical claims processing, and maintain a commitment to delivering high- quality service.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Mentor a team of medical claims processors, providing guidance and support to ensure team members meet performance goals and professional development.
• Foster a positive and collaborative team environment that encourages continuous improvement and open communication.
• Oversee the daily operations of the claims department, ensuring timely and accurate
• processing and adjustment of medical claims,
• Review and resolve complex claims issues, discrepancies, and denials in collaboration with team members and other departments.
• Monitor claims workflow and allocate resources effectively to maximize efficiency.
• Develop and deliver training programs for new and existing team members on claims processing procedures, coding, and compliance regulations.
• Stay updated on industry trends, changes in regulations, and emerging technologies related to medical claims processing.
• Work closely with other departments, including billing, coding, and customer service, to resolve claim-related issues and enhance overall operational efficiency.
• Engage with external stakeholders, such as insurance companies and healthcare providers, to facilitate effective claims resolution.
• Prepare and present regular reports on team performance, claims metrics, and operational challenges to senior management.
• Analyze claims data to identify trends and make recommendations for process improvements.
• Executes other responsibilities assigned by senior leadership.

REQUIRED EXPERIENCE

• At least 2+ years of proven experience in claims adjudication, including PPO and/or Medicaid, ERISA, Medicare, Level Funded and Self-Funded Experience with various claim payment systems in processing hospital, mental health, dental and routine medical claims within given deadlines, with at least 2-3 years in a leadership or supervisory role.
• Excellent Working Knowledge of MS Access, Google Sheets and Excel required
• Knowledge of medical terminology, ICD-10, CPT, and HCPCS coding.
• Excellent computer and keyboarding skills, including familiarity with Windows
• Excellent interpersonal & problem-solving skills.
• Excellent verbal and written communication skills to communicate clearly and effectively with all levels of staff, members, and providers.
• Ability to be focused and sit for extended periods of time at a computer workstation.
• Ability to work in a team environment and manage competing priorities
• Ability to calculate allowable amounts such as discounts, interest, and percentages

REQUIRED EDUCATION, LICENSES and/or CERTIFICATIONS

Bachelor’s/Associate degree preferred, or equivalent work experience.