Top 60 Claims lead Jobs in Boca Raton Fl

Revenue Cycle & Claims Operations Lead
Porter Cares, Inc. —Pompano Beach, FL
- $115,000 - $150,000 a year
- Full-time
- Remote
- Analysis skills
- Mentoring
- Senior level
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Lead Claims Examiner I
AmTrust Financial Services, Inc. —Boca Raton, FL
- Full-time
- Microsoft Outlook
- Research
- Mid-level
- Health insurance
- Dental insurance
Healthcare Market Finance Lead
Humana —Fort Lauderdale, FL
- $104,000 - $143,000 a year
- Full-time
- CPA
- Office
- Master's degree
- Paid parental leave
- Paid holidays
Lead Data Analyst - Medical Data
NCCI —Boca Raton, FL
- $75,000 - $85,000 a year
- Full-time
- Background check
- Pass drug screening
- Research
13d
Claims Team Lead
Medical Air Services Association, Inc —Sunrise, FL
- $31.28 an hour
- Full-time
- Hybrid work
- Mid-level
- Office
- 3 years
- Health savings account
- Disability insurance
Quick Apply
Lead Facilities Worker - Beach Maintenance
City of Fort Lauderdale, FL —Fort Lauderdale, FL
- $24.36 - $37.76 an hour
- Full-time
- CDL B
- 5 years
- Sanitation
- Disability insurance
- Health insurance
Garnishment Team Lead - Operations Department
US DEFAULT GROUP INC —Plantation, FL
- Full-time
- Mid-level
- 3 years
- Mentoring
- Paid holidays
- Health insurance
PIP/Personal Lines Auto/SIU - Partner/Unit Lead
Kelley Kronenberg —Fort Lauderdale, FL
- $150,000 - $225,000 a year
- Full-time
- 5 years
- Writing skills
- Team management
- Profit sharing
- Paid holidays
Quick Apply
Partner/Group Lead (Workers Compensation Defense)
Kelley Kronenberg —Fort Lauderdale, FL
- $200,000 - $250,000 a year
- Full-time
- 5 years
- Writing skills
- Mentoring
- Profit sharing
- Health insurance
Quick Apply
Attorney Partner/Unit Lead - Employment Law
Kelley Kronenberg —Fort Lauderdale, FL
- $250,000 - $300,000 a year
- Full-time
- 5 years
- Writing skills
- Business development
- Profit sharing
- Health insurance
Quick Apply
Influencer Marketing Lead (On-Site)
Integra Beauty —Dania Beach, FL
- Full-time
- Mid-level
- 3 years
- In-person
- Dental insurance
- 401(k)
Quick Apply

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Revenue Cycle & Claims Operations Lead

Porter Cares, Inc. -
Pompano Beach, FL

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Job Details

Full-time
$115,000 - $150,000 a year

Qualifications

Healthcare claims management
Contract documentation review
Vendor contracts
Contract review
Data analysis reporting
Requirements specification
Finance
Contract interpretation
Vendor coordination
Configuration management
Contract management experience in healthcare
Invoice matching
Invoice reconciliation
Vendor relationship management
Medical billing account reconciliation
Analysis (software development lifecycle)
Cross-functional collaboration
Healthcare data reporting
Cross-functional communication
HEDIS

Full Job Description

Porter is hiring a Revenue Cycle & Claims Operations to join our Team!

Porter combines the power of analytics with the power of care. Porter is a leading healthcare IT and services platform for care and coverage coordination that optimizes outcomes and member experience. We deliver understanding, compassion, information, and peace of mind for your members. Driven by robust AI analytics, Porter’s Care Guide team helps the member navigate the healthcare delivery system, secures the right support for each member’s specific needs, and directs Porter’s team of expert clinicians to perform comprehensive in-home assessments, complete with lab and diagnostic testing. By coordinating the complexities of each unique care journey, Porter helps close the gaps with the largest impact on quality measures, total cost of care, risk adjustment, and member experience.

ABOUT THE ROLE

Our organization operates in a payer-contracted services model — including delegated services, in-home assessments, HEDIS gap closure, and risk adjustment visits — rather than traditional fee-for-service care. Our billing patterns vary by payer and may include “penny claims” for encounter reporting paired with separate plan invoicing, or full-cost claims billed at the full contracted (allowable) rate.

Our EMR/RCM platform, Athena, is built around traditional fee-for-service economics: maximizing collections, flagging low-dollar claims as errors, and defaulting to standard allowable-amount and co-insurance logic. This creates a persistent structural mismatch with our billing model.

We are hiring a Revenue Cycle & Claims Operations Lead to own this problem end-to-end: to understand our payer contracts and billing models deeply, to configure and manage Athena as effectively as the platform allows, to build the reporting infrastructure needed to see what's actually happening to our claims, and to make a clear, well-supported recommendation on whether our long-term path is continued mitigation within Athena or migration to a different platform.

KEY RESPONSIBILITIES

Athena Configuration & Payer Alignment

Serve as the primary internal owner of Athena claim edit rules, hold queues, and workflow configuration as they relate to our non-FFS billing model.
Partner directly with Athena's professional services / support team to build and maintain custom rules that suppress inappropriate low-dollar (“penny claim”) edits and prevent unwanted allowable-amount or co-insurance recalculation on contracts where the full billed amount is the contracted rate.
Translate payer contract terms (rate structures, encounter-reporting requirements, invoicing arrangements) into correct system configuration.
Maintain a living documentation set of every custom rule, workaround, and configuration decision made in Athena, including rationale and payer applicability.

Claims Operations & Oversight

Ensure claims are reaching payers as intended and reconcile discrepancies between what was submitted, what was accepted, and what was paid or invoiced.
Identify and clear inappropriate Athena holds; distinguish true data/coding issues from false positives generated by FFS-oriented logic.
Track and resolve partial payments, particularly where Athena's allowable-amount logic conflicts with contracted full-payment terms.
Oversee the separate plan-invoicing process for encounter/penny-claim arrangements, ensuring invoices reconcile against submitted encounters.

Reporting & Analysis

Design and maintain recurring reports covering: claim submission status, current holds and aging, partial payment / underpayment tracking, and payer-specific exception trends.
Direct and review the work of the Billing & Claims Analyst in building and running these reports.
Surface patterns (e.g., a hold type recurring across many claims for one payer) and use them to drive systemic fixes rather than one-off corrections.

Strategic Recommendations

Lead a structured 90-day assessment of Athena's fit for our billing model (see companion scoping document) and deliver a clear recommendation: continue to mitigate within Athena, or scope a transition to an alternative platform.
If migration is recommended, lead requirements-gathering and RFP scoping for a replacement EMR/RCM system suited to delegated/value-based billing models.
Proactively bring forward recommendations — process changes, payer conversations, system configuration, or staffing — rather than waiting to be asked.

REQUIRED QUALIFICATIONS

5+ years of revenue cycle management or claims operations experience in healthcare.
Direct, hands-on experience with value-based care, risk adjustment, HEDIS/quality gap closure, delegated services, or other non-fee-for-service payer arrangements —
Practical experience configuring Athena (or a comparable EMR/RCM platform), including working with vendor support/professional services teams on custom edit rules and workflow changes.
Ability to read and interpret payer contract language and translate contractual terms into system requirements.
Strong analytical and reporting skills; comfortable building reconciliation reports and communicating findings to finance leadership.
Demonstrated ability to work cross-functionally with finance, operations, and external vendor teams, and to advocate persistently when a vendor's default assumptions don't fit the business model.

PREFERRED QUALIFICATIONS

Prior experience evaluating or migrating between EMR/RCM platforms.
Familiarity with encounter data reporting standards and delegated/capitated payer relationships.
Certification such as CRCR (Certified Revenue Cycle Representative) or equivalent.
Experience managing or mentoring junior billing/claims staff.

COMPENSATION & BENEFITS

Competitive wage and benefits package.

Opportunities for professional growth and continuing education.

A supportive, collaborative work environment.

We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.

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Refine Your Search

claims lead jobs in boca raton fl

Revenue Cycle & Claims Operations Lead

Lead Claims Examiner I

Healthcare Market Finance Lead

Lead Data Analyst - Medical Data

Claims Team Lead

Lead Facilities Worker - Beach Maintenance

Garnishment Team Lead - Operations Department

PIP/Personal Lines Auto/SIU - Partner/Unit Lead

Partner/Group Lead (Workers Compensation Defense)

Attorney Partner/Unit Lead - Employment Law

Influencer Marketing Lead (On-Site)

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