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Claims Production Team Lead

Company: Cambia Health
Location: Yakima
Posted on: January 15, 2022

Job Description:

Primary Job Purpose
Remote within: OR, WA, ID and UT
At Cambia, our members need us more than ever, and to continue serving them, we need to be vaccinated. Following federal mandate, all Cambia Health Solutions employees, including 100% remote workers, need to be fully vaccinated for COVID-19 by 1/1/22.
The Member Services Lead assists their supervisor in accomplishing and supporting department and corporate strategic objectives by organizing, monitoring, training and scheduling staff activities to meet or exceed performance standards and service level goals. They keep lines of communication open between management and staff, and establish excellent rapport with all levels of staff and external customers. The Lead may also function as a technical resource for the department or, alternatively, may focus on training and coaching employees, depending on needs of the particular department. This position leads employees but has no reporting subordinates.
General Functions and Outcomes



  • Handle difficult or escalated calls, claims or inquiries from members, providers, employer groups, agents, member representatives and internal customers with timely follow through.


  • Thoroughly research inquiries, complaints and requests for adjustments, take appropriate steps to correct any errors. Communicate decision with supervisor, staff, and customer. Share information gathered; provide helpful reminders to staff to ensure correct procedures are followed consistently.


  • Answer questions for team members and provide coaching and assistance, as needed. May provide training to team members as well as staff from other departments in an effort to promote internal customer service.


  • Ensure superior customer service to both internal and external clients and be accountable by following through on commitments.


  • Assist in monitoring and distributing staff workload and assist with workload as necessary to meet service requirements.


  • Assist supervisor in improving performance by participating in meetings, identifying training needs and making recommendations for on-going training, orienting new employees, and reinforcing learning through coaching. Provide feedback and coaching to employees on routine performance issues, as directed by supervisor.


  • Assist supervisor in establishing department goals by gathering service information from reports covering status of work, inventories, turnaround, attendance, timeliness, quality and quantity performance measures of employees. Assist in identifying and evaluating trends, developing a course of action and evaluating outcomes.


  • Assist in the maintenance of reference manuals and procedure guidelines. May assist in generating user documentation of processes, policies, and procedures in response to business changes and ensure staff is updated on any changes or modifications.


  • Troubleshoot system malfunctions and coordinate with IT as necessary. Identify business and technical problems, trends or irregularities and recommend appropriate solutions.


  • Participate in system enhancements, development, coordination, testing and implementation.


  • Assist in interviewing applicants and may provide input to supervisor regarding performance of employees.


  • Back up supervisor as needed.


  • Comply with MTM and Consortium standards as they relate to the employee's responsibility to meet BlueCross BlueShield Association (BCBSA) standards and corporate goals.


  • Willing to work overtime and on weekends as needed.


  • Represent department as a member of company-wide teams and work groups.

  • Complete special projects and reports as assigned.

    Minimum Requirements


    • Excellent verbal and written communication skills with the ability to interpret and communicate information with tact, diplomacy, patience and professionalism.


    • Demonstrated analytical ability in identifying problems, developing solutions, and implementing a course of action.


    • Demonstrated PC Skills including Word, Excel and Outlook and other corporate software program or comparable software.


    • Ability to prioritize and delegate work.


    • Ability to serve as a resource to correct technical and/or system(s) problems.


    • Ability to recognize inappropriate or invalid claims or inquiries and research, resolve and communicate resolution to concerned parties.


    • Ability to listen and communicate appropriately with provider community, members, employer groups, agents, member representatives, and coworkers in a manner that promotes positive, professional interaction while maintaining confidentiality.

    • For Government Programs related jobs, knowledge of State and Federal Regulations.

      Normally to be proficient in the competencies listed above
      The Member Services LD would have a High School diploma or GED and minimum five years progressive work experience in customer service, claims processing, membership billing or enrollment, as applicable to position, or equivalent combination of education and experience. Healthcare experience preferred.
      Work Environment


      • Sitting and working at a PC for extended periods of time.

      • Travel may be required.

        This position includes 401(k), healthcare, paid time off, paid holidays, and more. For more information, please visit www.cambiahealth.com/careers/total-rewards.
        We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.
        If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.

Keywords: Cambia Health, Yakima , Claims Production Team Lead, Professions , Yakima, Washington

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