Team Leader

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Team Leader Job Description- Healthcare Programs

Job Summary

The Team Leader is responsible for overseeing the day-to-day performance, development, and engagement of a team of Healthcare BPO Agents supporting U.S. healthcare programs. This role ensures achievement of operational, quality, compliance, customer experience, and productivity goals while providing leadership, coaching, and performance management support to frontline staff.

The Team Leader serves as the primary point of contact for team-related operational activities and acts as a liaison between agents, SMEs, Quality, Training, Workforce Management, and Operations Leadership. The position is responsible for driving employee performance, ensuring regulatory compliance, and supporting successful delivery of healthcare services across Medicare, Medicaid, Marketplace, Commercial Health Plans, Managed Care, Provider Services, Claims, Enrollment, Member Services, and Grievance & Appeals programs.

The ideal candidate possesses strong healthcare operations knowledge, leadership capabilities, coaching experience, and a commitment to delivering exceptional customer service in a highly regulated healthcare environment.

Key Responsibilities

Team Leadership & People Management

• Lead, supervise, and support a team of Healthcare BPO Agents to achieve operational and client objectives.
• Provide daily direction, guidance, and performance support to team members.
• Conduct regular one-on-one meetings, team huddles, coaching sessions, and performance reviews.
• Foster a positive, inclusive, and high-performance work environment.
• Monitor employee engagement, morale, attendance, and adherence to company policies.
• Recognize and reward strong performance while addressing performance concerns appropriately.
• Support employee development, career growth, and succession planning initiatives.

Performance Management & Coaching

• Monitor team performance against established Key Performance Indicators (KPIs).
• Analyze performance trends and identify opportunities for improvement.
• Deliver coaching and development plans focused on quality, productivity, compliance, customer satisfaction, and attendance.
• Conduct call reviews, side-by-side coaching, and performance evaluations.
• Collaborate with SMEs, Quality Assurance, and Training teams to improve agent effectiveness.
• Ensure agents receive timely feedback and support to meet performance expectations.

Operational Management

• Manage daily workflow and operational activities to ensure service-level commitments are achieved.
• Monitor staffing levels, schedule adherence, and productivity throughout the day.
• Coordinate with Workforce Management to address staffing requirements and operational needs.
• Support real-time management of queues, service levels, and workload distribution.
• Escalate operational concerns and risks to leadership as appropriate.
• Assist with implementation of process updates, system changes, and operational initiatives.

Customer Experience & Escalation Support

• Support agents in resolving complex member, provider, and customer inquiries.
• Manage customer escalations and ensure timely, professional resolution.
• Promote a customer-first culture focused on service excellence and issue resolution.
• Monitor customer satisfaction trends and implement corrective actions as needed.
• Partner with SMEs and Operations Leadership to address recurring customer concerns.
• Ensure positive customer experiences while maintaining compliance standards.

Quality & Compliance Management

• Ensure adherence to HIPAA Privacy and Security regulations.
• Promote compliance with CMS guidelines, Fraud, Waste & Abuse (FWA) requirements, and client-specific standards.
• Monitor quality scores and implement action plans to improve team performance.
• Support audit readiness and compliance initiatives.
• Reinforce operational policies, procedures, and regulatory requirements.
• Identify compliance risks and escalate concerns through appropriate channels.

Reporting & Performance Analysis

• Review and analyze team performance reports, dashboards, and scorecards.
• Track key metrics including productivity, quality, customer satisfaction, attendance, and compliance.
• Prepare operational updates and performance summaries for leadership.
• Identify trends, risks, and opportunities for continuous improvement.
• Support business reviews and operational performance discussions.

Training & Employee Development

• Support onboarding, nesting, and transition activities for new hires.
• Partner with Training teams to ensure successful knowledge transfer and skill development.
• Reinforce training content and operational best practices.
• Identify knowledge gaps and recommend refresher training opportunities.
• Promote continuous learning and professional development within the team.

Continuous Improvement & Process Excellence

• Participate in process improvement initiatives and operational projects.
• Identify opportunities to improve efficiency, quality, and customer experience.
• Collaborate with cross-functional teams to implement operational enhancements.
• Support change management activities and new program implementations.
• Drive accountability and continuous improvement within the team.

Additional Responsibilities

• Support Annual Enrollment Period (AEP), Open Enrollment, and other healthcare business initiatives.
• Act as a backup resource for Operations Managers when required.
• Participate in client meetings, calibration sessions, and operational reviews as needed.
• Assist with special projects and business initiatives.
• Perform other duties as assigned by leadership.

Required Qualifications

Experience

• Minimum 3 years of experience in a healthcare contact center, healthcare BPO, managed care, health insurance, or healthcare services environment.
• Minimum 1 year of leadership, supervisory, coaching, SME, or senior agent experience.
• Experience supporting Medicare, Medicaid, Marketplace, Commercial Health Plans, Managed Care, Provider Services, Claims, Enrollment, Member Services, or Grievance & Appeals programs.
• Experience managing performance metrics and employee development activities.
• Experience handling customer escalations and operational issue resolution.

Knowledge

Strong understanding of U.S. healthcare industry concepts, regulations, and contact center operations.

Working knowledge of:

• HIPAA Privacy and Security Regulations
• CMS Guidelines
• Fraud, Waste & Abuse (FWA)
• Healthcare Compliance Requirements
• Health Insurance Products and Member Services
• Grievance and Appeals Processes
• Contact Center Performance Metrics
• Quality Assurance and Customer Experience Standards

Understanding of workforce management principles, performance coaching methodologies, and healthcare operational processes.

Skills

• Strong leadership, coaching, and mentoring capabilities.
• Excellent verbal and written communication skills.
• Strong analytical and problem-solving abilities.
• Effective conflict resolution and employee relations skills.
• Ability to manage multiple priorities in a fast-paced environment.
• Strong organizational and time-management skills.
• Proficiency with Microsoft Office Suite (Excel, PowerPoint, Word, Outlook).
• Experience using CRM systems, workforce management tools, and operational reporting platforms.
• Ability to motivate teams and drive performance improvement.

Preferred Qualifications

• Experience leading remote, hybrid, or multi-skilled teams.
• Experience working with quality management, workforce management, or training functions.
• Leadership, Coaching, Healthcare Compliance, or Customer Experience certifications preferred.

Performance Requirements

• Consistently demonstrate leadership, professionalism, accountability, and integrity.
• Maintain compliance with all company, client, HIPAA, CMS, FWA, and regulatory requirements.
• Meet or exceed established team performance goals related to quality, productivity, attendance, customer satisfaction, and compliance.
• Demonstrate the ability to coach, motivate, and develop high-performing teams.
• Foster a positive and collaborative team environment.
• Support operational excellence through effective people management and performance leadership.
• Drive continuous improvement initiatives that enhance customer experience and business results.
• Protect confidential healthcare, client, employee, and company information at all times.

If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!