Claims Technical Lead

    • Job Tracking ID: 512935-664797
    • Job Location: Meridian, ID
    • Job Level: Mid Career (2+ years)
    • Level of Education: High School/GED
    • Job Type: Full-Time/Regular
    • Date Updated: January 10, 2019
    • Years of Experience: 2 - 5 Years
    • Starting Date: ASAP
    • Salary Type:: Hourly
    • Rate:: 15.23 + DOE
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Job Description:

The Claims Technical Team Lead assists the Claims Supervisor in monitoring Claims staff and providing internal and external customer service in the Claims department.

Key Result Areas

  • Assists Claims Supervisor in keeping assigned clients at the required turn-around-time (TAT).
  • Understands the performance standards to be met for all clients and assists in meeting these goals.
  • Assists in identifying process improvement areas and creating training documentation to support changes.
  • Provides question time with staff on a consistent basis.
  • Provides one-on-one training with existing processors when new procedures are implemented.
  • Assists other departments with question and problem resolution as it relates to claims issues.
  • Provides feedback related to performance reviews.
  • Provide suggestions related to performance improvement plans.
  • Handles large-claim audits as necessary.
  • Handles escalated issues through the EXC queue.
  • Provides training for new hires in the claims department and monitors their performance during the training time period.
  • Reviews medical records as needed to make claims determinations.
  • Monitors members in Stop Loss at the end of a group’s plan year.
  • Assists staff with reviewing and appealing external audit errors.
  • Assists with work distribution for select groups.
  • Prepares and presents issues at the weekly processor meetings as needed.
  • Manual updates of accumulators as needed.
  • Assists in the interview and hiring process for claims processors.
  • Performs other duties as assigned or needed.

Experience and Skills:

  • High school graduate or equivalent.
  • 4-5 years’ prior claims processing experience.
  • Extensive knowledge of medical and dental terminology.
  • Extensive knowledge of GBAS System.
  • Ability to delegate and meet deadlines.
  • Maintain confidentiality at all times.
  • Good problem solving and analytical skills as well as ability to prioritize workload.
  • Types 45 wpm, 10-key by touch, and computer knowledge.
  • Able to demonstrate excellent attendance and punctuality.
  • Excellent customer service attitude and professionalism.
  • Demonstrate Accuracy, Customer Service, Timely Turn-Around (ACT).
  • Exceptional verbal and written communication skills.
  • Proficiency using Microsoft Office (Word, Excel, Outlook, etc.).
  • Ability to work efficiently, perform multi-tasking, prioritize tasks, and meet tight deadlines.
  • Possess a high degree of integrity and discretion, as well as the ability to adhere to both company policies and best practices.
  • Ensure compliance with security practices and procedures, including HIPAA and HITRUST standards.
  • Ability to efficiently and effectively perform the Key Result Areas with or without a reasonable accommodation without posing a direct safety threat to others or self.
  • Protect and enhance the Core Purpose and the Core Values of AmeriBen.

AmeriBen is an Equal Opportunity/Affirmative Action Employer committed to creating an environment of diversity and inclusion for equal employment and advancement opportunities to all employees and applicants for employment. All qualified applicants will receive consideration for employment without regard to race, religion, color, age, national origin, sex, sexual orientation, gender identity and/or expression, genetic information, disability, veteran or military status, or any other category protected by federal, state and/or local law.

If you are unable to use our online application process due to a disability, please contact the Human Resources Department at humanresources@ameriben.com.