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MedPro Group

Claims Team Lead

MedPro Group, Springfield, Massachusetts, us, 01119

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Overview

Wellfleet, a Berkshire Hathaway company, delivers customer-centric accident and health insurance, with quality service and uncompromising ethics. Wellfleet works to protect people against risk throughout every stage of life – from grade school to college to the workplace. Founded in 1993 as Consolidated Health Plans (CHP), Wellfleet, headquartered in Springfield, Mass., is one of the nation’s leading providers of health and accident insurance products to the higher education market. Join our rapidly growing and fast paced health insurance organization in the Springfield area. The ideal candidate in this position will assist the Claims Supervisor in the technical and operational functions of the claims unit, including but not limited to compliance with company standards and industry best practices; to ensure consistent delivery of quality services; assist with staff training and development and questions. Responsible for certain administrative duties associated with our accounts.

Responsibilities

Communicate with Clients, Policyholders and Agents as required

Assist Account Managers with questions as necessary

Work with staff on professional development and identifying career goals and aspirations of team members

Review reports (audit, inquiry, etc.) to identify trends and areas for process improvement and identify additional training opportunities

Contribute agenda items for weekly claims meeting to foster a culture of focusing on ways we can improve our services to better meet the needs of our customers

Maintain thorough understanding of all equipment, methods, and procedures

Demonstrate good oral and written communication skills and provide clear communication to staff

Develop and implement appropriate training programs for Claims personnel to maximize performance and skills in consultation with HR and the Claims Supervisor

Maintain confidentiality

Handle difficult situations and persons in a positive and professional manner

Motivate others to reach their potential and drive results

Be self-motivated with the ability to work independently with very little direction

Monitor and keep accurate track of timesheets and PTO while meeting company staffing needs

Assist Claims Supervisor with performance reviews

Participate in the screening and hiring process

Ensure staff respond timely to all appeals and DOI complaints that need reprocessing

Ensure staff are processing claims accurately and timely

Ensure staff respond timely to inquiry forms

Perform random claim audits as needed

Handle special projects

Establish and maintain a high level of positive working relationships with internal and external customers

Keep current with benefits

Meet KPIs and operating plan deliverables

Ensure client-specific and company SLA’s are met

Keep management informed of problems and issues

Handle escalated issues

Perform other duties as assigned

Qualifications

Bachelor’s Degree is preferred, or a minimum of 5 years claims processing experience

Must have recent experience in the health insurance industry to support our clients

Must have demonstrated experience as a leader

Knowledge and familiarity with CPT, HCPC, ICD-10 codes and medical terminology

Excellent oral, written and interpersonal communication skills

Ability to lead and remain calm and professional when facing challenges

Demonstrates the ability to work well in a team environment

Ability to be flexible in prioritizing workloads to meet changing deadlines

Ability to handle constantly changing situations with ease

Excellent skills in MS Office products

Why Wellfleet? Here at Wellfleet, we foster a culture of growth that enables engaged and high-performing professionals to be empowered to deliver our mission and vision.

Our employees are a team devoted to providing customer service that exceeds expectations of our members and clients. Successful team members continually look for ways to improve product delivery and value.

Wellfleet offers a competitive compensation package and comprehensive benefits package including life, health and dental, vision, 401K retirement plan, short- and long-term disability coverage, flexible/dependent care spending account, tuition reimbursement, and business casual dress.

Are you interested in exploring a career at Wellfleet? Explore our open positions. #LI-KS1 #LI-Remote

General Wellfleet is part of the MedPro Group family. As such, all Wellfleet team members are employees of MedPro Group Inc. We are an Equal Opportunity Employer.

Wellfleet, a Berkshire Hathaway company, delivers customer-centric accident and health insurance, with quality service and uncompromising ethics. Wellfleet works to protect people against risk throughout every stage of life – from grade school to college to the workplace. The annual gross base salary range is $55,000 to $67,000. This range anticipates the low and high end of the salary for this position. Actual salaries will vary and are based on factors such as a candidate’s qualifications, skills and competencies. Salary is one component of Wellfleet’s total compensation and benefits package, which includes medical, vision and dental insurance options, life and accident insurance, 401(k), and short-term and long-term disability insurance. For a more detailed overview, visit our careers website at: wellfleetinsurance.com/about/careers. #LI-KS1

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