Healthcare Claims Team Lead (Healthcare)

TL;DR

Healthcare Claims Team Lead (Healthcare): Leading end-to-end client implementations and medical claims adjudication processes with an accent on Medicare and Medi-Cal regulatory compliance. Focus on translating client requirements into operational workflows and managing team performance during new client go-lives.

Location: Remote (Must be based in the US)

Salary: up to $3,979 per month ($23 per hour)

Company

hirify.global is a leading provider of back-office support technology and tech-enabled outsourced services for 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, and staffing models.
• Partner with Training, QA, IT, and Workforce Management to ensure cross-functional readiness.
• Design and validate claims processing workflows, including escalation paths and exception handling.
• Manage team oversight, performance reporting, and general leadership responsibilities.
• Own Quality Assurance and Training functions during the implementation phase.

Requirements

• Must be based in the United States
• Min. 5 years of experience processing easy, moderate, and complex medical claims (payer-side preferred).
• 2+ years in a leadership role within claims or healthcare operations.
• Proven experience in implementations, transitions, or new client launches.
• Strong experience with Medicare and Medi-Cal claims and working knowledge of CMS guidelines.
• Prior experience in quality assurance and training with an ability to identify trends.

Culture & Benefits

• Remote work arrangement with equipment provided.
• Paid training to ensure operational success.
• Comprehensive benefits: Medical, Dental, Vision, Life, and HSA.
• 401(k) retirement plan.
• Paid Time Off (PTO) and 7 paid holidays.
• Company culture that values internal growth and support.