Claims Examiner Lead

Claims Examiner Lead page is loaded## Claims Examiner Lead locations:
Remote Oregon:
Remote Washington time type:
Full time posted on:
Posted 2 Days Agojob requisition :
JR100581

Claims Examiner Lead---------------------------------------------------------------The Claims Examiner Lead works under the direction of the Claims Examiner Supervisor to manage the daily operations of the Claims Examiner team. This position is responsible for assisting with work distribution, individual performance tracking, and measuring competency and production levels. The role is also responsible for responding to technical questions from claims examiners and assisting the supervisor in implementing new processes, procedures, and may perform some auditing.

This position may provide training to internal users on the plan benefit matrix and claims policies/procedures as well as provide assistance to the Claims Department leadership team. Duties include processing claims and acting as a role model for the staff.
** Estimated Hiring Range:**$25.42 - $31.07
** Bonus Target:
** Bonus - SIP Target, 5% Annual Current Care Oregon Employees:
Please use the internal Workday site to submit an application for this job.

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** Essential Responsibilities
*** Evaluate complex and difficult medical, dental, and behavioral health claim which may result in adjudication, re-adjudication or adjustments of claims in accordance and/or compliance with plan provisions, State/Federal regulations, and Care Oregon policies/procedures.
* Provide excellent customer service to internal and external customers.
* Utilize Care Oregon on-line phone tracking system to document all activities from any mode of communication as defined by Care Oregon and Claim Department policies.
* Consistently meet or exceed Department and Company policies including but not limited to quality, production, attendance, conduct.
* Determination eligibility, benefit levels, coordination of benefits with other carriers, recognize and investigate third party issues which may require working with attorneys or outside agents.
* Assist the claims supervisor in mentoring new or existing claims examiners which includes auditing employee work, identifying ways in which quality and productivity can be improved, and adjustments can be minimized.
* Assist claims examiners with claims processing and other questions.
* Continuously learn and stay up to date with changing processes, procedures and policies.
* Proactively work to build and improve the team.
* Independently manage special projects as assigned by the supervisor.
* Identify trends and communicate findings and process improvement ideas to the supervisor.
* Work collaboratively with other Care Oregon departments to ensure timely, accurate, and effective claims adjudication.
* May develop reference documentation for department use.
* Provide training to new employees on specific tasks related to their job responsibilities.
* Coordinate with departments and external vendors to ensure all aspects of the projects have been appropriately addressed.

Employee Leadership
* Provide leadership for a team in support of team direction and goals.
* Provide input into staffing needs; assist in recruiting and hiring staff, using an equity, diversity, and inclusion lens.
* Participate in organizing, scheduling, monitoring and improving work; help ensure employees have information to meet job expectations and have coverage during absences.
* Contribute to the development, communication, and oversight of team and individual goals.
* Train, lead, and coach employees; may facilitate team meetings.
* Incorporate guidance from Care Oregon equity tools into people leadership.
* Help monitor employee adherence to department and organizational standards, policies, and procedures.
* Assist in evaluating employee performance, providing feedback to support success, recognizing strong performance, and addressing performance gaps and accountability (corrective action).
* Perform lead tasks in collaboration with Human Resources as needed.###
** Experience and/or Education
** Required* Minimum 3 years’ experience as a medical…