Claims Team Leader (2 Positions)

Job Summary:

The incumbent in this position will assist the Claims Manager in the technical and operational functions of the claims unit, including but not limited to; compliance with company standards and industry best practices; to ensure consistent delivery of quality services; to be responsible for staff development, and assist with staff questions.

Minimum Qualifications:

  • Must have recent experience in the health insurance industry to support our clients
  • Must have demonstrated experience as a leader
  • Knowledge and familiarity of CPT, HCPC, ICD-10 codes and medical terminology
  • Excellent oral, written and interpersonal communication skills
  • Ability to lead and demonstrate remaining calm and professional when facing challenges
  • Demonstrates the ability to work well in a team environment
  • Ability to be flexible in prioritizing workloads to meet changing deadlines
  • Ability to handle constantly changing situations with ease
  • Excellent skills in MS office products
  • Bachelor’s Degree is preferred or a minimum of 5 years claims processing experience

    Essential Functions and Responsibilities

  • Communicate with Clients, Policyholders and Agents as required
  • Assist Account Managers with questions as necessary
  • Works with staff on professional development and identifying career goals and aspirations of team members
  • Review of weekly audit reports to identify trends and areas for process improvement and identifies additional training opportunities
  • Holds weekly claims meeting with team to foster a culture of focusing on ways we can improve our services to better meet the needs of our customers    
  • Must have thorough understanding of all equipment, methods, and procedures
  • Good oral and written communication skills and is expected to give clear communications to staff
  • Develops and implements appropriate training programs for Claims personnel to maximize their performance and skills in consult with HR and the Claims Manager  
  • Must maintain confidentiality
  • Ability to handle difficult situations and persons in a positive and professional manner
  • Ability to motivate others to reach their potential
  • Ability to mentor and coach the team by leading by example
  • Monitor and keep accurate track of timesheets, PTO while meeting company staffing needs
  • Assist Claims Manager with performance reviews
  • Participates in the screening and hiring process
  • Ensure staff is responding timely to all appeals and DOI complaints that need reprocessing
  • Ensure staff are processing claims accurately and timely
  • Ensure staff is responding timely to inquiry forms
  • Perform random Claim Audits as needed
  • Ability to handle special projects
  • Establish and maintain a high level of positive working relationships with internal and external customers
  • Keep current with benefits
  • Keep management informed of problems and issues   
  • Handle escalated issues

    Standards for claims processors need to be met as follows:

  • Insure mailbox standards are met in each and every category every day
  • Procedural Accuracy 98% and Financial Accuracy 99%
  • TAT 85% processed within 14 calendar days and 90% process within 30 calendar days
  • Inquiry forms must be handled within 3 business days

    Reports to: Claims Manager


    Please send your resume and completed application to CHP Human Resources at:

    Mail: Consolidated Health Plans, Human Resources, 2077 Roosevelt Avenue, Springfield, MA 01104-3503

    Fax: (413) 452-5329 Attn. Human Resources


    Phone: (413) 733-4540 ext. 120


    Employment Application

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    For more information contact us at or call us at (413) 733-4540 ext. 120