Claims Team Lead

Overview Director of Human Resources for International Brands, VUMI Group — Full-time, non-exempt — Miami, Florida — Hybrid About VUMI VUMI (VIP Universal Medical Insurance Group) is an international health insurance company committed to providing premier medical insurance products and VIP healthcare services to individuals and corporations worldwide. With operational offices in Panama, Ecuador, Colombia, and across the globe, we offer unique benefits and extensive global coverage. Privately owned and backed by over 35 years of experience in the healthcare industry, VUMI employs a diverse team of 500+ professionals and is part of a leading international healthcare group. Join a top team of healthcare professionals driving innovation and excellence at one of the leading IPMI (International Private Medical Insurance) organizations in the industry. About You You are a knowledgeable and driven insurance professional with a strong understanding of claims handling procedures and insurance principles. With hands-on experience in the areas you lead, you bring a proactive, solutions-oriented mindset and a passion for continuous improvement. You excel at guiding and supporting team members, resolving complex claims, and maintaining high standards of accuracy and compliance. You're a confident communicator—able to handle escalations with professionalism—and you foster strong working relationships across teams. Bilingual in Spanish and/or Portuguese, you're comfortable navigating multicultural environments and thrive in dynamic, fast-paced settings. Your background in insurance or healthcare, along with your skills in process improvement, billing systems, and performance analysis, makes you a valuable contributor to operational excellence. If you’re someone who leads by example, embraces challenges, and is committed to delivering exceptional service, we’d love to meet you. POSITION SUMMARY The Claims Team Lead is responsible for providing guidance and support to a team of claims adjudicators and coordinators, helping ensure the accurate and timely processing of insurance claims. This role involves leading by example, resolving complex cases, supporting team development, and serving as a point of escalation—all while ensuring compliance with company policies and regulatory standards. The Team Lead plays a key role in promoting collaboration, efficiency, and service excellence within the claims team. ESSENTIAL FUNCTIONS Essential Duties and Responsibilities Assign claims to team members based on workload and assignment of responsibility (AORs). Monitor individual claim progress and key performance metrics. Provide coaching, constructive feedback, and development opportunities to team members. Support resolution of performance issues and team conflicts. Review escalated claims for accuracy, completeness, and compliance with company policies and procedures. Investigate and resolve complex claims requiring in-depth analysis. Identify and escalate potentially fraudulent claims in accordance with protocols. Contribute to the implementation of strategies that improve claims processing efficiency and accuracy. Monitor and report on customer satisfaction related to claims handling. Generate performance reports, including metrics such as claim volume, productivity, and turnaround times. Analyze performance data to identify trends, gaps, and areas for continuous improvement. Share performance insights and recommendations with management. Address and resolve escalated customer inquiries or complaints related to claims. Foster and maintain positive relationships with internal departments and external stakeholders. MINIMUM QUALIFICATIONS & SKILLS High school diploma or equivalent required In-depth understanding of insurance principles and claims handling procedures Demonstrated expertise in assigned claims areas with a track record of success Strong leadership skills with the ability to motivate and guide team members Excellent analytical and problem-solving capabilities Clear and effective communication skills, both verbal and written Strong interpersonal skills with the ability to collaborate across teams Proficiency in industry-related systems, tools, and technology Knowledge of medical coding (preferred) Ability to thrive in a fast-paced environment and meet tight deadlines PREFERRED QUALIFICATIONS Experience in the insurance and/or healthcare industry Bilingual in Spanish and/or Portuguese Proven experience in process improvement and change management to drive operational efficiency Advanced knowledge of accounts receivable practices and billing systems BENEFITS At VUMI, the well-being of our employees is our top priority. We offer a robust benefits package that includes: Medical, Dental, and Vision Insurance 401(k) Retirement Plan Life Insurance Short-Term Disability (STD) Coverage Long-Term Disability (LTD) Coverage Paid Time Off (PTO) Paid Holidays Hybrid Work Model (combination of remote and in-office work) Wellness Programs, including free access to our building gym A vibrant, engaging work environment that values and supports our employees’ growth, well-being, and success WORKING CONDITIONS The following job-related working conditions are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential function. WORK ENVIRONMENT The role primarily operates in an in-door, climate-controlled office setting working in close proximity to others. Noise level in the work environment is low to moderate. Light level provides adequate brightness for reading, computer work, and other tasks without causing glare or strain. PHYSICAL DEMANDS The job primarily involves sedentary work with prolonged periods sitting at a desk. While performing the duties of this job, employees may occasionally be expected to: exert up to 10 pounds of force and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects. operate standard office equipment such as copiers, computers, telephones, printers, etc. TRAVEL Minimal to no travel required SAFETY HAZARD OF THE JOB Minimal Hazards including potential ergonomic risks from prolonged sitting or repetitive motions. EEO STATEMENT VUMI Group is an equal opportunity employer. We celebrate diversity and are committed to an inclusive environment for all employees. NOTE This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. All duties and responsibilities are subject to modification to reasonably accommodate individuals with disabilities. The requirements listed in this job description are the minimum levels of knowledge, skills, or abilities necessary. This job positing does not create an employment contract, implied or otherwise, other than an “at will” relationship. #J-18808-Ljbffr

Created: 2025-10-08