Claims Examiner, TL

Worldwide Salaried Open

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:

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