Claims Service Supervisor- West Sacramento, CA (Hybrid)

Summary

As a Claims Service Supervisor, you will be responsible for overseeing the day-to-day operations of healthcare claims processing team, ensuring claims are adjudicated accurately, efficiently, and in compliance with regulatory requirements, and client contracts. Providing leadership, coaching, quality oversight, and operational support to claims examiners and analysts while driving continuous process improvements and service excellence.

Your role in our mission

• Supervise and lead a team of healthcare claims examiners and analysts.
• Monitor claim inventory, turnaround times, productivity, and quality metrices to ensure service level agreements (SLAs) are achieved.
• Assumes supervisory responsibility of electronic and paper claims submissions; oversees analysis, correction and eligibility of edits and errors.
• Analyze claim trends, denial patterns, and operational performance data to identify process improvement opportunities.
• Develop and maintain standard operations procedures (SOPs) and training materials.
• Lead, motivate, coach, and develop team members while addressing performance concerns and taking corrective action when necessary.
• Conduct employee performance evaluations and development planning.
• Promote best practices across all levels of the team to improve consistency, productivity, and quality.
• Use Microsoft Excel to analyze operational data, reconcile information, identify trends, and prepare reports for leadership.
• Monitor and report on team performance, including productivity, quality, inventory, and throughput metrics.
• Identify workflow challenges, reporting discrepancies, and opportunities to improve team processes, accuracy, and efficiency.

What we're looking for

• 3-5+ years of experience in healthcare operations or Medicaid-related functions.
• 5+ years of supervisory or people leadership experience.
• Experience in one or more of the following areas: medical billing, claims adjudication, medical records or healthcare analytics.
• Experience managing performance metrics, including KPIs, SLAs, productivity, and quality standards.
• Excellent communication and interpersonal skills with the ability to engage effectively in a client-facing environment.
• Ability to manage multiple priorities, meet deadlines, and operate effectively in a fast-paced, high-volume environment.
• Strong proficiency in Microsoft Excel, including the ability to analyze data, reconcile information, identify discrepancies, and produce operational reports.

What you should expect in this role

. What you should expect in this role

• Fast-pace, metrics-driven claims environment require prioritization, and timely decision-making.
• Regular collaboration with Workforce Management, Quality, Operations, project teams, and leadership stakeholders.
• Responsibility for monitoring operational performance and supporting improvements tied to claims adjudication.
• Participation in project meetings, client-facing preparation, client interface, and operational planning activities as needed.
• Hybrid role is predominantly work from home, with occasional in-office work required based on business, operational, client, or leadership needs.
• Must be willing to work Monday through Friday 7:00am to 4:00pm
• Video cameras must be used during all interviews, as well as during the initial week of orientation.

To work effectively as a teleworker or hybrid positions with Gainwell, employees must have a broadband internet connection with a minimum speed of 24 Mbps download and 8 Mbps upload. Higher speeds are recommended for optimal performance. To test your internet speed, go to Google and search for “Internet Speed Test.”

The deadline to submit applications for this posting is August 13, 2026.