Claims Examiner TL - Remote (Healthcare Claims)

TL;DR

Claims Examiner Team Lead (U.S. Claims): Lead end-to-end client implementation for new healthcare claims processing engagement with an accent on process design, operational readiness, and cross-functional coordination. Focus on translating requirements into scalable workflows, mitigating risks, and ensuring production-ready systems for go-live.

Location: Remote (US)

Pay: $22–$25 per hour

Company

Leading provider of tech-enabled outsourced back-office services and claims processing to US healthcare plans nationwide.

What you will do

• Lead end-to-end client implementation from discovery through go-live and stabilization.
• Translate client requirements into operational workflows, SOPs, staffing models, and detailed plans with timelines.
• Coordinate with Training, QA, IT, and Workforce Management for system setup, UAT, and readiness.
• Develop process documentation, validate workflows for claims processing, escalations, and exceptions.
• Handle team oversight, performance management, QA, and training during implementation phase.

Requirements

• Min. 5 years processing easy, moderate, and complex medical claims (payer-side preferred)
• 2+ years in leadership role within claims or healthcare operations
• Proven experience in implementations, transitions, or new client launches
• Strong experience with Medicare and Medi-Cal claims, CMS guidelines, and regulatory requirements
• Prior QA and training experience with trend identification
• Experience leading or mentoring teams in claims or healthcare operations
• Strong analytical skills for performance data and KPIs
• Excellent communication, organizational, and decision-making skills

Culture & Benefits

• Remote work with equipment provided
• Paid training
• Comprehensive benefits: Medical, Dental, Vision, Life, HSA, 401(k)
• Paid Time Off (PTO) and 7 paid holidays
• Supportive team focused on internal growth