Healthcare Team Leader | Provider Services

Healthcare Team Leader | Provider Services

Work Set-up: Onsite - eligible to WFH after training based on performance and business requirements

Location: Valero, Makati City
Schedule: Graveyard | Shifting Hours

Job Summary

The Healthcare Team Leader - Provider Services is responsible for leading, coaching, and managing a team of Healthcare Customer Service Advocates who support healthcare providers and billing representatives with eligibility, claims, payments, appeals, Explanation of Benefits (EOBs), and other provider-related inquiries.

The Team Leader is accountable for driving team performance against established productivity, quality, attendance, schedule adherence, service-level, customer/provider experience, compliance, training, certification, and other account-specific Key Performance Indicators (KPIs). This role ensures Advocates follow approved workflows, accurately document interactions, meet client expectations, and receive timely coaching and performance support.

This role partners closely with Operations, Quality, Training, Workforce Management, and other support teams to ensure service delivery excellence, operational readiness, compliance adherence, and sustained performance improvement across the team.

Key Responsibilities

Team Leadership & Operations Management

• Lead a team of Healthcare Customer Service Advocates supporting provider-service inquiries across applicable channels, including phone, email, fax, web inquiries, and other designated communication channels.
• Ensure daily operational coverage, workflow execution, queue management, and timely resolution of provider inquiries within the assigned scope of work.
• Monitor real-time and daily team performance, including productivity, quality, attendance, schedule adherence, service levels, turnaround time, documentation accuracy, and escalation performance.
• Provide direction, support, and floor assistance to Advocates handling complex, escalated, or sensitive provider interactions.
• Ensure team members accurately research systems and approved resources before communicating provider-facing information.
• Coordinate with Operations, Workforce Management, Quality, Training, and client-facing support teams to address operational gaps, service risks, and performance trends.
• Maintain ownership of assigned team results and ensure timely follow-through on action plans, escalations, and performance commitments.

Quality, Accuracy & Coaching

• Drive team quality performance by reviewing QA results, identifying error trends, and ensuring corrective actions are completed within established timelines.
• Conduct regular coaching sessions, one-on-one meetings, performance reviews, and development discussions with assigned Advocates.
• Partner with Quality and Training teams to ensure Advocates understand audit criteria, documentation expectations, call-handling standards, and process requirements.
• Validate that provider interactions are documented accurately and completely in designated systems.
• Lead root-cause discussions for repeat errors, compliance risks, process misses, and customer/provider experience concerns.
• Reinforce a Zero Error Mindset across the team focused on preventing avoidable errors and protecting provider and member experience.
• Escalate potential compliance concerns, process discrepancies, or situations that could result in incorrect information being provided to a provider.

Production Responsibilities

• Perform regular production work within the assigned account in addition to Team Lead responsibilities.
• Maintain hands-on proficiency in all applicable processes and work types supported by the team by routinely completing actual production transactions.
• Meet the established Team Lead production requirement and assigned production volume/cadence.
• Maintain a 100% quality standard on all production work completed by the Team Lead.
• Follow all client requirements, workflows, documentation standards, regulatory requirements, and production procedures applicable to frontline employees.
• Demonstrate subject-matter expertise through accurate completion of production work and model the performance and quality standards expected of the team.
• Maintain production responsibilities on a regular basis and not solely during periods of high volume, staffing shortages, or service-level challenges.
• Immediately address and report any errors identified within the Team Lead's own production work.

Team Productivity & KPI Accountability

• Ensure the assigned team consistently meets all established account KPIs, including productivity, quality, attendance, schedule adherence, service level, documentation accuracy, transfer/escalation expectations, turnaround time, customer/provider experience, training, certification, and compliance requirements.
• Review team dashboards, scorecards, QA results, attendance records, and operational reports to identify risks and opportunities for improvement.
• Develop and execute action plans for Advocates or sub-teams not meeting required performance standards.
• Ensure performance expectations are clearly communicated, understood, documented, and reinforced with team members.
• Understand that KPI requirements may be updated based on client requirements, operational needs, or changes to the scope of work.

Training, Certification & Nesting Support

• Support new-hire orientation, structured training, certification, nesting, production-readiness, and graduation activities for assigned Advocates.
• Monitor trainee and new-hire performance during nesting and early production, including PKT results, QA results, productivity, attendance, adherence, and progression against graduation expectations.
• Partner with Training and QA teams to identify knowledge gaps and recommend refresher training, workshops, boot camps, role-playing, simulations, or other targeted development activities.
• Ensure Advocates complete required training, assessments, certifications, recertifications, acknowledgments, and compliance requirements within established timelines.
• Maintain team awareness of client requirements, process changes, system updates, operating procedures, and performance expectations.

New-Hire & Early Production Performance

• Manage close monitoring of new-hire performance through the first 90 days in production following graduation.
• Use productivity, QA scores, post-training PKT results, individual errors, attendance, schedule adherence, coaching outcomes, and overall progression to determine development needs.
• Recommend additional coaching, refresher training, targeted development, performance-management actions, or onsite work requirements when employees do not demonstrate expected progression.

Provider Experience & Escalation Management

• Ensure the team delivers professional, courteous, confident, and solution-oriented service during every provider interaction.
• Coach Advocates on clear communication, active listening, appropriate probing, accurate benefit and claims explanations, and proper handling of difficult or complex interactions.
• Review escalated provider concerns and ensure appropriate research, resolution, documentation, and handoff in accordance with approved procedures.
• Identify avoidable transfers, repeat issues, or unresolved inquiries and work with support teams to improve first-contact resolution and provider experience.
• Maintain professionalism and sound judgment when supporting escalated, sensitive, or compliance-related provider matters.

Compliance & Security

• Ensure team compliance with HIPAA requirements and all applicable privacy, security, confidentiality, client, and Imagenet standards.
• Reinforce required caller/provider verification practices before team members access, discuss, or disclose protected information.
• Monitor adherence to access controls, documentation standards, approved workflows, and escalation requirements.
• Immediately report and escalate suspected privacy, security, compliance, unauthorized-access, or process-integrity concerns.
• Ensure assigned team members complete required compliance training and acknowledgments within established timelines.

People Management & Performance Documentation

• Conduct regular one-on-one meetings, coaching sessions, performance reviews, development discussions, and team huddles.
• Document coaching, attendance discussions, quality reviews, performance gaps, corrective actions, employee acknowledgments, and follow-up commitments accurately and timely.
• Address performance, behavior, attendance, adherence, and compliance issues in accordance with company policy and established operational processes.
• Recognize strong performance, reinforce positive behaviors, and support employee engagement, accountability, and retention.
• Escalate recurring or serious performance concerns Operations leadership and Human Resources as appropriate.

Qualifications

• High school diploma or equivalent required; college degree or relevant post-secondary education is preferred.
• At least 4-5 years of experience in a healthcare contact center, provider services, claims support, or comparable healthcare operations environment.
• At least 1 to 2 years of team leadership and supervisory experience preferred.
• Working knowledge of healthcare claims, EOBs, appeals, eligibility, benefits, payment processes, provider-service workflows, and contact-center operations.
• Demonstrated ability to coach employees, interpret performance data, identify root causes, and drive measurable performance improvement.
• Ability to work in a metric-driven environment and manage team performance against productivity, quality, attendance, adherence, service-level, and compliance requirements.
• Experience with Monday.com, AWS Connect, workforce tools, QA platforms, and performance dashboards is highly preferred.
• Ability to work flexible schedules, including nights, weekends, and holidays, based on client coverage and leadership requirements.

Performance Accountability

Team Leaders are accountable for the performance, quality, compliance, engagement, and operational readiness of their assigned team regardless of work location. Remote or hybrid work is contingent upon sustained leadership effectiveness, team performance, responsiveness, and compliance with all applicable requirements. Failure to meet established KPIs or leadership expectations may result in coaching, retraining, performance management, return to onsite work, or other appropriate action in accordance with company policy.

Work Arrangement & Remote Work Eligibility

This position may require onsite presence during training, transition, new-hire nesting, team stabilization, client visits, performance-management activities, or other operational needs.

Team Leaders may be eligible for a remote or hybrid work arrangement, subject to sustained team performance, leadership effectiveness, attendance, responsiveness, security, technology, client, and business requirements.

Additional Benefits:

• Comprehensive HMO Coverage - Medical & Dental
• HMO coverage on Day 1 plus 1 dependent

COMPANY OVERVIEW

Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet 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. 

The 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.  The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually.  The company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients.

Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines.