Claims Examiner Team Leader (Healthcare)

TL;DR

Claims Examiner Team Leader (Healthcare): Leading and managing a team of 15–20+ claims examiners to ensure accurate, compliant, and timely processing of medical claims with an accent on Medicare and Medi-Cal regulations. Focus on driving performance against SLAs, coaching team members, and implementing process improvements to enhance operational efficiency.

Location: Must be based in the United States (Remote, Pacific Time Zone schedule).

Salary: Up to $22.00 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

• Supervise and support a team of 15–20+ claims examiners while maintaining personal production targets.
• Provide ongoing coaching, mentoring, and real-time feedback to improve quality and productivity.
• Ensure strict compliance with Medicare requirements, CMS guidelines, and client policies.
• Monitor and manage service level agreements (SLAs), turnaround times, and error rates.
• Analyze performance data and KPIs to identify trends, operational risks, and training opportunities.
• Collaborate with QA, Training, and IT departments to resolve workflow issues and implement new policies.

Requirements

• Minimum 5 years of experience processing medical claims (easy to complex).
• 2+ years of leadership experience in claims or healthcare operations.
• Strong working knowledge of Medicare and Medi-Cal claims and CMS regulatory requirements.
• Proven ability to identify performance trends and conduct quality assurance audits.
• Excellent analytical skills with the ability to interpret KPIs and performance data.
• Must be available to work on a Pacific Time Zone schedule.

Culture & Benefits

• Comprehensive benefits package including Medical, Dental, Vision, and Life insurance.
• Financial planning support with HSA and 401(k) options.
• Paid Time Off (PTO) and 7 paid holidays.
• Equipment provided for remote work.
• Paid training program to ensure role success.
• Supportive environment focused on internal growth and professional development.