Team Lead - Claims Processing

Company: Hispanic Alliance for Career Enhancement
Location: Franklin
Posted on: May 26, 2025

Job Description:

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position SummaryThe Team Lead for the Medicare Supplement Claims Processing team is responsible for overseeing day-to-day operations to ensure timely, accurate, and compliant adjudication of claims. This role provides leadership, coaching, and support to claims processors while partnering with internal stakeholders to drive performance, improve efficiency, and enhance the customer experience. The Team Lead plays a key role in supporting the supervisor and ensuring departmental goals are met by understanding inventory and SLA's.---Provide daily direction and oversight to a team of claims processors handling Medicare Supplement claims.---Monitor team productivity, quality, and turnaround time; identify trends and escalate issues as needed to leadership.---Serve as a subject matter expert on Med Supp claim guidelines, system functionality, and regulatory requirements.---Respond to complex claim inquiries, escalations, and process exceptions with professionalism and accuracy.---Partner with the supervisor to track KPIs, conduct performance reviews, and support employee development plans.---Collaborate with other departments including Customer Service, Provider Relations, and Medical Review to resolve cross-functional issues and improve workflow.---Lead or contribute to continuous improvement initiatives, system updates, and process enhancements.---Ensure compliance with internal policies and CMS/state regulations governing Medicare Supplement claims.---Step in to assist with claims processing during peak volumes or staffing shortages.

Required Qualifications---3+ years of experience in health insurance claims processing, preferably with Medicare Supplement claims.---Proven ability to lead or mentor others in a team environment.---Strong knowledge of CMS guidelines, NAIC model regulations, and Med Supp plan structures.---Excellent analytical, problem-solving, and decision-making skills.---Strong written and verbal communication skills.---Ability to prioritize multiple tasks and work effectively under pressure.---Proficiency in tools such as Excel, SQL, Tableau.

Preferred Qualifications---Prior leadership or team lead experience.---Demonstrated ability to work cross-functionally and drive performance outcomes.

Education--- High school diploma or equivalent work experienceAnticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$18.50 - $35.29This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.For more information, visitWe anticipate the application window for this opening will close on: 05/19/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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Keywords: Hispanic Alliance for Career Enhancement, Murfreesboro , Team Lead - Claims Processing, Other , Franklin, Tennessee