Claims Examiner, TL

Job Description:

• Lead end-to-end client implementation, from discovery through go-live and stabilization
• Translate client requirements into operational workflows, SOPs, and staffing models
• Develop and execute detailed implementation plans, including timelines and milestones
• Identify risks early and proactively drive mitigation strategies
• Partner with Training, QA, IT, and Workforce Management teams to ensure readiness across all workstreams
• Coordinate system setup, user acceptance testing (UAT), and access provisioning with IT and client teams
• Ensure all systems, tools, and environments are fully tested and production-ready prior to go-live
• Support development of process documentation, job aids, and knowledge base materials
• Validate workflows for claims processing, including escalation paths and exception handling
• Ensure processes are scalable, efficient, and aligned with client expectations
• Performance management, reporting, and oversight during the implementation phase

Requirements:

• Min. 5 years of experience processing easy, moderate, and complex medical claims (payer-side experience preferred)
• 2+ years in a leadership role within claims or healthcare operations
• Proven experience in implementations, transitions, or new client launches
• Strong experience with Medicare and Medi-Cal claims, including a working knowledge of CMS guidelines and regulatory requirements
• Prior quality assurance and training experience with demonstrated ability to identify trends
• Previous experience leading, coaching, or mentoring teams in a claims or healthcare operations environment
• Strong analytical skills with the ability to interpret performance data and KPIs
• Excellent communication, organizational, and decision-making skills
• High attention to detail and commitment to accuracy, compliance, and operational excellence

Benefits:

• Remote work offered
• Equipment provided
• Paid training to set you up for success
• Comprehensive benefits: Medical, Dental, Vision, Life, HSA, 401(k)
• Paid Time Off (PTO)
• 7 paid holidays
• A supportive team and a company that values internal growth

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