Medical Operations Claims Recovery Team Lead (Remote Any City, USA) - Any city, TX, US, 99999

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. 

Summary

We are seeking a dynamic and experienced Training and Quality Assurance Team Lead to join our team. The ideal candidate will possess a comprehensive understanding of training methodologies, quality assurance procedures, and claims processing guidelines. This individual will be responsible for overseeing the training programs for new hires as well as conducting refresher training sessions for existing staff. Additionally, the Training and Quality Assurance Team Lead will play a pivotal role in developing training content, including videos, standard operating procedures (SOPs), and other documentation to ensure consistency and accuracy across the organization.

Your role in our mission

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· Lead and coach claims recovery collectors to make contact with carriers and providers in order to drive document and payments recoveries on behalf of our clients

· Perform regular quality checks based on metrics and performance data

· Conduct audits of claims processing to ensure adherence to quality standards and regulatory requirements as requested by leadership

· Handle escalated calls from more junior team members as the initial point of contact and be the subject matter expert for a team of Operations agents

· Act as back up for supervisor as needed

· Confer with carriers by telephone or use Web sites to determine member eligibility and claim status

· Assess denials, pursue appeals or close claims when appropriate

· Update case management …