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Position Summary The Team Lead manages the day-to-day operational activities and leads a team of auditors and support staff in the Fraud, Waste and Abuse (FWA) program. This position ensures that the team delivers quality medical review work consistent with set expectations and required quality standards. The role involves coordination with internal and external teams, supervision of technical staff, and identification of trends for continuous performance and quality improvements.

The Team

Lead bridges operational excellence with staff development and strategic program initiatives.

Key Responsibilities

Team Lead Operational & Clinical Responsibilities

- Conduct reviews of medical records and claims in support of fraud, waste and abuse investigations or for other program integrity initiatives.
- Prepare written medical review summaries outlining rationale for claims determinations.
- Maintain current knowledge of relevant regulations and standards, including federal and state policies and coding guidelines.
- Supervises and coaches auditors and support staff, providing ongoing training on FWA processes and medical review standards.
- Develops and conducts investigation-related and compliance training programs.
- Meets daily and monthly production and quality targets.
- Maintains exemplary accuracy in all review work and ensures team members maintain established quality standards.
- Communicates effectively and timely with upstream functional areas to resolve issues.
- Reviews team performance based on historical data, quality scores,



and metrics generated by MIS and QA departments.
- Reviews documentation entered by subordinates to maintain data quality and compliance.
- Actively involved in client communications to discuss feedback on team member performance and program progress.
- Liaison between support functions and operations to ensure smooth functioning of day-to-day activities.
- Participates in regular calibration calls with colleagues, quality assurance staff, and in office managers to ensure consistency and compliance on process knowledge.
- Responsible for data management in terms of dashboards and reporting results to clients.
- Ensures adherence to required login hours, productive time, and other standards set by clients.
- Organize continuous feedback sessions with the team to address quality parameters and process improvements.
- Assists in and leads the team in modification of process guidelines and materials associated with new functionality or reporting requirements.
- Identifies trends in case data and recommends process improvements for enhanced efficiency and quality.

Team Lead Leadership & Management Responsibilities
- Effectively lead and manage a team of auditors and support staff on FWA projects.
- Select, train, develop, assign, and evaluate direct reports.




- Recommend or initiate human resources actions.
- Minimize absenteeism and manage attrition by creating a positive, supportive work environment.
- Works collaboratively to achieve team and departmental results.
- Communicates and supports company and departmental goals and objectives.

Education: Any Graduate Certification: CPC (Certified Professional Coder)

Experience Requirements

- 4-6 years of healthcare management experience with substantive background in claim processing, medical review, data management, and data analysis.
- 2+ years of supervisory or team leadership experience.
- Experience in FWA investigations, medical review, or healthcare compliance programs.
- Proficient with Microsoft Office Suite (Word, Excel, PowerPoint).
- Experience with claim processing systems and healthcare data management tools.
- Effective communicatorboth written and verbal.
- Ability to work well independently and collaboratively in a team environment.
- Ability to handle multiple tasks, prioritize, and meet deadlines consistently.
- Ability to positively handle and manage stress, including high work volume and frequent change.
- Ability to learn new material quickly and apply it effectively.
- Team player with strong desire to assist others and share knowledge.
- Excellent analytical and problem-solving skills; ability to identify root causes and develop solutions.
- Flexibility in thought and approach to problem-solving.
- Willingness to participate in an international organization's work processes, including conference calls across global time zones.

📌 Medical Coding Team Lead (Pune)
🏢 Cotiviti
📍 Pune