Team Lead Care Coordinator

Company: Prime Care Benefits Group
Position: Team Lead Care Coordinator
Location: Remote (Occasional Onsite Attendance Required)
Employment Type: Full-Time
FLSA Classification: Non-Exempt (Hourly)
Union Status: Union-Represented Position
Reports To: Senior Lead of Strategic Operations

Prime Care Benefits Group is seeking an experienced, motivated, and customer-focused Team Lead Care Coordinator to join our team!

This position is ideal for someone who enjoys helping others, has strong knowledge of healthcare benefits administration, and is ready to take on a leadership role.

As a Team Lead Care Coordinator, you will serve as a key resource for our Care Coordination team, providing daily guidance, coaching, training, and operational support while ensuring members and providers receive exceptional service.

You will work closely with the Senior Lead of Strategic Operations to maintain performance standards, improve workflows, and support the team's continued success.

This is a remote position with occasional required onsite attendance for meetings, training, and operational needs.

Team Leadership & Support

• Provide day-to-day guidance, coaching, and operational support to Care Coordinators.

• Serve as the primary resource for team members regarding referrals, authorizations, eligibility verification, and dental and vision benefit inquiries.

• Monitor daily workloads and assist with distributing tasks to ensure timely completion.

• Train and onboard new Care Coordinators and support ongoing employee development.

• Assist with monitoring productivity, call quality, processing accuracy, and performance standards.

• Identify workflow challenges and recommend improvements to enhance efficiency and customer service.

• Serve as the first point of escalation for complex member, provider, and operational concerns.

• Assist leadership with quality reviews, reporting, audits, and departmental projects.

• Foster a positive, collaborative, and accountable team environment.

Member & Provider Support

• Answer incoming calls from members, providers, and office staff regarding dental and vision benefit plans.

• Assist with eligibility verification, benefit coverage, referral and authorization status, and general plan inquiries.

• Resolve member and provider concerns professionally, accurately, and efficiently.

• Document all interactions thoroughly in the appropriate systems.

• Collaborate with internal departments to resolve claims, eligibility, authorization, and service-related issues.

Referral & Authorization Processing

• Review, enter, and process dental and vision referrals and authorization requests.

• Ensure referrals and authorizations are processed accurately and within 48 hours of receipt.

• Review submitted requests for completeness and accuracy.

• Assist team members with complex referrals, authorization requirements, and benefit-related questions.

• Support compliance with established procedures, turnaround times, and quality standards.

Quality, Compliance & Performance

• Support call center performance goals, including an abandonment rate below 3% and an average speed to answer of less than 30 seconds.

• Monitor team performance and assist leadership in identifying opportunities for improvement.

• Help maintain accuracy and consistency in referral and authorization processing.

• Ensure professional communication and the protection of confidential member information.

• Follow HIPAA regulations, company policies, and applicable service requirements.

• Participate in leadership meetings, training sessions, coaching, and operational reviews.

Required:

• High school diploma or equivalent.

• Strong verbal and written communication skills.

• Excellent customer service, problem-solving, and…