Team Lead (State Operations)

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Job description

Overview:
Job Summary

The Team Lead of Arbitration will supervise and coordinate the staff's daily operations. This role will have the overall responsibility for mentoring and developing skills of direct reports. The Team Lead will participate in evaluation and implementing quality control and performance improvement activities.

Responsibilities:
Essential Job Duties and Responsibilities

Analyze workflow reports to determine cases eligible for IDR Process

Assist with identification of trends by Arbitrator/Health Plan

Identify system errors

Develops and organizes reports into a format that can easily be evaluated by Leadership

Have the ability for re-prioritizing key tasks and meet with upper management to provide updates of findings and outcomes

Work with external vendors such as State Department of Insurance (DOI) personnel and arbitrators to assist with issues and resolutions

Complete special projects and other duties as assigned

Strong organizational, analytical, and problem-solving skills

Knowledge of the insurance industry

Professionalism in all dealings, both internal and external customers

Ability to clearly communicate, both verbally and in writing

Strong understanding of insurance plans and policies

Ability to motivate and train employees

Proven ability to maintain high productivity standards

Develop a strategy that the team members can use to better reach a project goal

Assign tasks to team members

Ability to keep team within KPI standard or find improvement to surpass improvements

Determine the completion timeline and monitor progress to keep the project on track and on schedule

Communicate clear instruction to team members

Manage the flow of day-to-day operation

Knowledge of medical terminology

Other duties as assigned

Qualifications:
Education and/or Experience

High School degree or equivalent required

Minimum of 2 years Revenue Cycle Management Experience

IDR experience preferred

Leadership experience preferred

Skills/Specialized Knowledge

Strong organizational analytical and problem solving skills

Knowledge of insurance industry

Knowledge of independent dispute resolution process

Ability to clearly communicate both verbally and in writing

Knowledge of medical terminology

Knowledge of CPT, and/or ICD-10

Friendly, outgoing personality

Basic knowledge of company policies and procedure

Knowledge of legal and regulatory government provisions

Knowledge of laws that regulates communication and privacy act. HIPAA laws and understanding of the application of all above

Experience with MS Office applications including Word, Excel, Access, Outlook, PowerBI

Other Requirements

Must maintain professional appearance

Ability to be at work at regular and consistent times

Physical and Mental Demands

This position will spend long hours sitting and using office equipment and computers. The position may also entail light lifting of supplies and materials occasionally, up to and including 20 pounds in addition to reaching, stooping, standing, and walking. This position requires the ability to talk, hear, compare, compute, compile, copy, analyze, coordinate, synthesize, negotiate and communicate. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions.

Work Environment

Remote work environment, ability to work independently and in a group environment

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