Team Lead - Claims Adjudication:

Job Title:Team Leader - Claims Adjudication:
Location: MDI NetworX
Experience: 6+ years

About MDI NetworX:
MDI NetworX is a global leader in business management solutions, providing innovative services to health plans, benefit administrators, and networks. Our mission is to reduce operational costs, enhance adjudication rates, and elevate customer service. We are committed to delivering high-impact solutions that drive efficiency and quality.
Learn more at - www.mdinetworx.com.

Position Overview:
MDI NetworX is seeking a Team Leader - Claims Adjudication

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Key Responsibilities:

• Supervise daily operations of the payer operations team.
• Ensure timely processing of claims, enrolments, and eligibility verifications.
• Monitor team performance, provide coaching, and drive productivity.
• Ensure compliance with HIPAA, ACA, and payer regulations.
• Handle escalations and resolve process-related issues.
• Collaborate with internal teams and clients to enhance service delivery.
• Generate reports on key performance metrics and process improvements.

Required Skills & Qualifications:

• Bachelors degree or equivalent experience.
• 4-6 years of experience in US healthcare payer operations.
• Strong knowledge of claims adjudication, enrolment, and provider data management.
• Experience managing teams and driving performance metrics.
• Proficiency in MS Office and healthcare payer systems.
• Excellent communication, problem-solving, and leadership skills.

Preferred Qualifications:

• Experience with Medicare, Medicaid, and commercial payer processes.
• Knowledge of EDI transactions (837, 835, 834).
• Prior experience in a BPO or shared services environment