Tres Health ยท 7 hours ago
Supplemental Products Team Lead (Remote)
United States
Full-time
Remote
Mid, Senior LevelTres Health is a company dedicated to transforming healthcare with innovative solutions. They are seeking a Supplemental Products Team Lead to manage, analyze, and optimize supplemental health products, ensuring claims are processed according to regulations and policies.
DentalHealth CareInsurance
Hiring Manager
Stephanie Loft, SHRM-CP
Responsibilities
Distribute claims to the analysts for daily processing. This includes answering any questions they have and going over key concepts utilized throughout the TPA industry and those specific to supplemental medical plans and benefits
Analyze supplemental products insurance claims submitted by providers, facilities, and claimants to ensure they meet policy criteria. Examine the details of the claim, including medical records, police reports, and other documentation
Determine the coverage provided by the insurance policy and evaluate the claim based on policy terms and conditions
Confirm the accuracy and authenticity of data between claims systems, eligibility feeds, and carrier files as well as all documentation submitted, including investigating potential fraud or discrepancies
Make decisions on whether the claims should be approved, denied, or adjusted, based on a thorough review of the evidence, accident letters received, COB obtained, etc
Review and evaluate claims processed by analysts to ensure accuracy, compliance, adjudication turnaround times, and payment integrity. Additionally, support internal & external audits by providing documentation, reconciliations, and process summaries
Be able to jump in and assist with any tasks or assignments provided by the management team
Adhere to insurance regulations and company policies to ensure all claims are processed in a legal and ethical manner
Other tasks as assigned
Qualification
Required
High School diploma is required
Previous experience in supplemental products claims processing, customer service, or a related field preferably in healthcare, insurance, or third-party administration (TPA) environment
Prior experience in a supervisor position would be a plus
Strong attention to detail to accurately assess and process claims
Ability to analyze complex information and make informed decisions
Strong written and verbal communication skills to interact with providers, members, and internal teams
Understanding of insurance terminology, policies, regulations, and EDI file formats
Ability to identify issues, think critically, and solve problems in a timely and efficient manner
Proficiency in using computer systems, claims management software, and basic office software (such as Microsoft Office)
Dedicated home office with reliable, high-speed internet
Secure workspace aligned with HIPAA security standards (device encryption, secure Wi-Fi, screen privacy)
Ability to effectively coordinate and lead projects in a fully remote environment
Adherence to Tres Health's security and privacy policies, including HIPAA compliance
Prolonged periods of sitting and working at a computer
Ability to communicate effectively through video, phone, and written platforms
Ability to effectively use computers, video conferencing tools, and other standard remote work technology
Visual and auditory capabilities suitable for remote work
Ability to occasionally lift up to 15 pounds
Company
Tres Health
Tres Health provides alternative health insurance with dental, vision, and hearing plans, emphasizing zero deductibles and co-pays.
Founded in 2021
11-50 employees
Funding
Current Stage
Early StageLeadership Team
Michael Feeney
Co-Founder
Company data provided by crunchbase