Claims Team Leader

Join PacificSource and help our members access quality, affordable care!

• →Provide supervision, coaching, training, evaluation and leadership to assigned staff. Assure claims processing, production and quality meet department and company standards.
• →Evaluate performance of team members. Analyze results of performance reports for each team member to determine training needs related to personal performance and department goals.
• →Oversee and assist team in providing exceptional claims processing service to members, providers, employers, agents and other insurance companies. Includes accurate interpretation of benefit and policy provisions.
• →Oversee and assist with review and research of medical and dental claims and determine coverage based on contract, provider status and claims processing guidelines. Investigate and settle claims issues as needed. Relay information for dispute resolution, including research and response for grievances and appeals, to appropriate departments and personnel.
• →Communicate changes in business processes and procedures to ensure team members receive information in a timely manner.
• →Work collaboratively with department Training Coordinator in all aspects of initial and continued education for assigned staff.
• →Oversee and assist with answering inquiries received by mail or e-mail, providing exceptional service. Write original business letters and prepare reports as needed.
• →Serve on various interoffice committees as required or needed. Document and report any pertinent communications back to the team and/or department.
• →Actively participate in Claims leadership peer group to ensure cross-team communication, collaboration and process efficiency result in consistent, quality claims processing outcomes.
• →Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• →Coordinate business activities by maintaining collaborative partnerships with key departments.
• →Assist with process improvement and work with other departments to improve interdepartmental processes. Utilize lean methodologies for continuous improvement. Utilize visual boards and daily huddles to monitor key performance indicators and identify improvement opportunities.
• →Actively participate as a key team member in department meetings.
• →Actively participate in various strategic and internal committees in order to disseminate information within the organization and represent company philosophy.

• →Actively participate in department or inter-departmental workgroups. Share information or issues with department leaders.
• →Regularly attend team meetings and daily team Visual Board huddle.
• →Meet department and company performance and attendance expectations.
• →Perform other duties as assigned.

Building Trust

Building a Successful Team

Aligning Performance for Success

Building Customer Loyalty

Building Strategic Work Relationships

Continuous Improvement

Decision Making

Facilitating Change

Leveraging Diversity

Driving for Results

Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

• We are committed to doing the right thing.

• We are one team working toward a common goal.

• We are each responsible for customer service.

• We practice open communication at all levels of the company to foster individual, team and company growth.

• We actively participate in efforts to improve our many communities-internally and externally.

• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.

• We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.