Medical Claims Team Leader (Medicine universities ONLY)

Planning & Monitoring Process

• Develop best practices to optimize claim processing quality.
• Evaluate professional skills of claim staff and provide appropriate claim assignments to them.
• Oversee medical, insurance and legal aspects of assigned claims. Interact with Claimant, Policies and others to ensure claim acceptance
• Assist in hiring and training new candidates in their job responsibilities.
• Monitor individual performance and ensure it meets expected quality and performance objectives.
• Develop professional development plans for employees to improve performance efficiency.
• Assist in employee performance evaluation, promotion, retention and termination activities.

Operational Excellence Process 

• Ensure that the claim team follows state regulations and standard operating procedures.
• Assist claim personnel in coverage investigation, liability analysis and acceptance negotiation.
• Document claim assessment and filing activities accurately.
• Provide daily support to claim staff on claim managing and filing activities.
• Managing statistical data to ensure that claims met the desired turnaround times and Metrics.

Additional job responsibilities 

The duties and responsibilities as set out above are not exhaustive and the role holder may be required to carry out additional duties within reasonableness of their level of skills and experience.