Team Lead - Claims Processing, CVS Health

CVS Health

Location:
United States, Franklin

Category:
Customer Service

Contract Type:
Employment contract

Salary:

18.50 - 35.29 USD / Hour

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Job Description:

The 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.

Job Responsibility:

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

Requirements:

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

Nice to have:

prior leadership or team lead experience
demonstrated ability to work cross-functionally and drive performance outcomes

What we offer:

affordable medical plan options
401(k) plan (including matching company contributions)
employee stock purchase plan
wellness screenings
tobacco cessation and weight management programs
confidential counseling
financial coaching
paid time off
flexible work schedules
family leave
dependent care resources
colleague assistance programs
tuition assistance
retiree medical access

Additional Information:

Job Posted:
May 31, 2025

Expiration:
June 16, 2025

Employment Type:

Fulltime

Work Type:

Hybrid work

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Team Lead - Claims Processing