Healthcare Operations Team Lead

STRATEGIC STAFFING SOLUTIONS (S3)

Position: Healthcare Operations Team Lead

Work Set-Up: Onsite

Office Location: Century Diamond Tower-Makati City

Schedule: Night Shift (EST)

S3 is looking for a Healthcare Operations Team Lead to support our healthcare insurance account in the Philippines. The Lead should be willing to help the team grow, guide a group of processors, perform coaching and continuous evaluation sessions, create reports as well as a documented plan to help resolve issues and build the team towards gearing success.

JOB RESPONSIBILITIES

As a Healthcare Operations Team Lead, you will be responsible for overseeing and leading a group of claims processors for accurately processing both manual and electronic claims, meeting production goals, ensuring high-quality standards, adhering to compliance policies, fostering a positive work environment, and actively contributing to continuous improvement efforts within the claims processing workflow and department. Claims Processors are handling clinical claims; this role is critical in ensuring the accurate and efficient processing of medical insurance claims.

The Claims Processing Team Lead is also expected to monitor daily operations of the claims processing team, ensuring accurate, timely, and compliant handling of insurance claims. This role involves supervising team members, coordinating workflows, providing training and support, and acting as a liaison between the claims team and management.

Key Responsibilities:

• Lead and manage the claims processing team to achieve departmental goals and performance targets.
• Monitor daily claims processing activities to ensure accuracy, quality, and adherence to company policies and regulatory requirements.
• Review complex claims to provide guidance and support to team members.
• Train, mentor, and develop team members to enhance their skills and productivity.
• Coordinate with other departments such as underwriting, customer service, and finance for smooth claims resolution.
• Identify process improvements and implement best practices to increase efficiency.
• Prepare regular reports on team performance, claim volumes, and operational metrics.
• Handle escalated issues and customer complaints professionally and promptly.
• Ensure compliance with legal and regulatory standards in claims handling.
• Participate in audits and provide necessary documentation or support.
• Participate in Hiring Process through interviews and feedback.

Qualifications:

• Bachelor's degree in Business Administration, Insurance, Finance, or related field preferred.
• At least 5 years of solid experience in claims processing, preferably in insurance or healthcare sectors.
• At least 3 years of prior experience in a supervisory or leadership role is a must.
• Strong knowledge of claims processing systems, insurance policies, and regulatory requirements.
• Excellent analytical, problem-solving, and decision-making skills.
• Effective communication and interpersonal skills.
• Ability to manage multiple priorities and meet deadlines.
• Proficient in MS Office and claims management software.