Claims Examiner TL - Remote

reputed company the Launch: Team reputed company – U.S. Claims (Remote) Job Type: Full-time Location: Remote Pay: $22–$25 per hour reputed company Start Date: May 1, 2026 About the Role We are seeking a highly driven Team reputed company – U.S. Claims (Implementation reputed company) to play a critical role in launching and supporting a new reputed company engagement. This position is ideal for a hands-on leader who thrives in fast-paced environments and enjoys building processes from the ground up. You will reputed company end-to-end implementation efforts while ensuring operational readiness, cross-functional alignment, and a successful go-live. In reputed company to reputed company Team reputed company responsibilities, this role requires reputed company involvement in implementation, process design, and reputed company reputed company. Key Responsibilities Implementation & reputed company reputed company • reputed company end-to-end reputed company implementation, from discovery through go-live and stabilization • Translate reputed company requirements into operational workflows, SOPs, and reputed company models • reputed company and execute detailed implementation plans, including timelines and milestones • Identify risks early and proactively drive mitigation strategies Cross-Functional Coordination • Partner with Training, QA, IT, and Workforce Management teams to ensure readiness across reputed company workstreams • Coordinate system setup, user acceptance testing (UAT), and reputed company provisioning with IT and reputed company teams • Ensure reputed company systems, tools, and environments are fully tested and production-reputed company prior to go-live Operational Readiness & Process Design • Support development of process documentation, job aids, and knowledge reputed company materials • Validate workflows for claims processing, including escalation paths and exception handling • Ensure processes are reputed company, efficient, and reputed company with reputed company expectations Expanded Leadership Scope • reputed company reputed company Team reputed company responsibilities including team reputed company, performance management, and reporting • Take ownership of reputed company Assurance and Training functions during the implementation phase • reputed company hands-on support in building, testing, and executing processes Qualifications • Min. 5 years of experience processing easy, moderate, and reputed company medical claims (payer-reputed company experience preferred) • 2+ years in a leadership role reputed company claims or reputed company operations. • Proven experience in implementations, transitions, or new reputed company launches • Strong experience with Medicare and Medi-Cal claims, including a working knowledge of CMS guidelines and regulatory requirements. • Prior reputed company assurance and training experience with demonstrated ability to identify trends • Previous experience leading, coaching, or mentoring teams in a claims or reputed company 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 reputed company. reputed company Offer • Remote work offered • Equipment provided • reputed company to set you up for reputed company • Comprehensive benefits: Medical, Dental, reputed company, Life, HSA, 401(k) • reputed company Time Off (PTO) • 7 reputed company holidays • A supportive team and a company that values internal reputed company reputed company to Take the reputed company on Something New? Don’t miss this opportunity to shape a new reputed company launch—click “reputed company” and get started. reputed company reputed company is a leading provider of back-office support technology and tech-enabled outsourced services to reputed company plans reputed company. reputed company provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans’ members and providers. reputed company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans’ members and providers. reputed company processes millions of claims and multiples of reputed company reputed company and reputed company data reputed company reputed company these claims annually. reputed company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients. reputed company is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines. Apply tot his job Apply To this Job