Healthcare Claims Team Lead

TL;DR

Healthcare Claims Team Lead (U.S. Claims): Lead end-to-end client implementation and operational readiness for healthcare claims processing with an accent on process design, cross-functional coordination, and go-live stabilization. Focus on translating client requirements into scalable workflows, mitigating risks, and ensuring compliance with Medicare and Medi-Cal guidelines.

Location: Remote (U.S.)

Pay: $22–$25 per hour

Company

hirify.global is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide, processing millions of claims annually with its JetStream workflow platform.

What you will do

• Lead end-to-end client implementation from discovery through go-live and stabilization
• Translate client requirements into operational workflows, SOPs, and staffing models
• Develop detailed implementation plans, identify risks, and drive mitigation strategies
• Coordinate with Training, QA, IT, and Workforce Management for system setup, UAT, and readiness
• Support process documentation, validate workflows for claims processing and exception handling
• Handle team oversight, performance management, QA, and training during implementation

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 regulations
• 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