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Team Leader

Team Leader

Infinite

5 - 7 years

7 - 9 Lacs

Bengaluru

Posted:Just now| Platform:

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Skills Required

Automation Claims Coding Process improvement Analytical Billing Healthcare Continuous improvement Analytics Recruitment

Work Mode

Work from Office

Job Type

Full Time

Job Description

Lead and oversee Third-Party Administrator (TPA) back-office operations focused on U.S. healthcare claims. Responsibilities include claims adjudication, enrollment, billing, escalations, QA, team supervision, KPI tracking, and compliance with CMS and HIPAA. Build and mentor a high-performing, service-oriented team
Key Responsibilities

Team Leadership & Supervision
Manage a team of TPA coordinators and claims processors providing guidance, training, performance feedback, and coaching Oversee recruitment, onboarding, and development of your team.
Claims Processing & Adjudication
Supervise end-to-end claims operations, ensuring accuracy, completeness, and SLA adherence Resolve escalated or complex claims issues with providers or internal teams.
Quality & Compliance
Conduct audits to verify claim accuracy, coding compliance (ICD-10, CPT), and medical necessity . Ensure alignment with CMS guidelines, HIPAA standards, and client-specific regulations.
Analytics & Process Improvement
Monitor key metrics (turnaround time, error rates, aged claims); prepare reports and present insights Identify inefficiencies and implement process improvements or automation.

Stakeholder Engagement
Liaise with insurers, healthcare providers, and internal departments (finance, billing) to drive resolution and efficiency .
Generate regular MIS reports: aging, disallowances, productivity, and compliance dashboards
Required Qualifications

Education: Bachelor s degree preferred (Healthcare Administration, Business, or related).
Experience:
- 5-7 years in healthcare claims processing/TPA operations.
- 1-2 years in a supervisory or leadership role specifically in TPA or claims.
- In-depth knowledge of CMS, HIPAA, coding standards (ICD-10, CPT), and claims adjudication.
Skills:
- Strong leadership, coaching, and interpersonal skills.
- Analytical mindset focused on metrics and continuous improvement.
- Proficiency in claims management systems and Microsoft Office tools.

High attention to detail, problem-solving ability, and regulatory compliance awareness

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