Medical Coding Quality Team Lead

About This Opportunity

Our talent team is representing a confidential health insurance organization in the United States. We are seeking a Medical Coding Quality Team Lead to supervise a claims audit team, ensure quality and production standards, and provide strategic leadership across medical, dental, and vision claims processing.

This is a remote opportunity where you will lead a team responsible for claims accuracy, fraud/waste/abuse review, stop-loss contract evaluation, and collaboration with compliance, appeals, and grievance teams. You will play a critical role in process improvement, staff development, and cross-departmental communication.

Responsibilities

• Supervise and coach the claims audit team, ensuring adherence to production and quality standards
• Evaluate team performance using reports and metrics; identify training needs and support development
• Oversee fraud, waste, and abuse claim review processes in collaboration with compliance
• Manage complex claims research, coverage determination, and dispute resolution across multiple lines of business (medical, dental, vision, self-funded, COBRA)
• Evaluate and administer stop-loss contracts; prevent aggregate violations and produce manual reporting
• Communicate procedural changes, participate in leadership peer groups, and drive process efficiency
• Collaborate with appeals and grievance teams to determine appropriate claims outcomes based on policy and regulatory requirements
• Oversee claims refunds team, including adjustments, collections, and month-end reconciliation
• Support hiring, onboarding, performance reviews, corrective actions, and one-on-one coaching
• Apply lean methodologies and visual management tools to drive continuous improvement
• Provide expert-level education to other departments on billing, coding, medical records review, and claims processing

What We're Looking For

• Minimum 4 years of complex claims management experience, including auditing, billing, research, and recovery, with demonstrated leadership capabilities
• At least 1 year of supervisory or team lead experience required
• Experience in self-funded claims administration preferred
• High school diploma or equivalent required
• Advanced knowledge of medical terminology, CPT/ICD-10 coding, and claims processing
• Thorough understanding of health insurance products, plan designs, provider relationships, and regulatory compliance
• Strong research, evaluation, and auditing skills with attention to detail and accuracy
• Advanced proficiency in Microsoft Word and Excel; skilled with 10-key, multi-line phone systems
• Excellent written and verbal communication skills; ability to influence and build trust across teams
• Commitment to continuous improvement, collaboration, and building customer loyalty
• Ability to travel approximately 5% of the time

How We Work with You

Candidates apply directly through Get A Job.ai. Our recruiting team will conduct an initial screening to understand your background and fit for the role. We then submit qualified candidates to our client for consideration. Please do not contact the client directly—we coordinate all communication and next steps on your behalf.

Pay

Pay details will be discussed during the screening process and are competitive with the market for this level of experience and responsibility.

Equal Opportunity: Get A Job.ai is committed to inclusive hiring practices. We welcome applicants of all backgrounds and work to ensure fair, equitable access to opportunities.