State Hearing Analyst - Roseville, CA - Hybrid

Summary

As a State Hearing Analyst at Gainwell Technologies, you will help support the health and well-being of vulnerable community members by ensuring fair and accurate review of Medi-Cal Dental appeals. Working with innovative technology and a collaborative team, you will play a key role in supporting healthcare programs and delivering positive outcomes for members.

This position is ideal for individuals who are passionate about problem-solving, analytical thinking, and customer service. As part of a team focused on accuracy, compliance, and quality, you will conduct secondary reviews of denied dental treatment authorization requests to determine eligibility for approval. When denials are upheld, you will prepare and process appeal and hearing documentation, ensuring compliance with program requirements while supporting members' appeal rights.

Your role in our mission

• Retrieve and review new Medi-Cal Dental appeals, researching denial information and member records. Compile and maintain all pertinent documentation using ACMS, MEDS, CD-MMIS, EIMS, and imaging vendor systems.
• Prepare radiograph requests and obtain missing information from providers and members. Draft Conditional Withdrawal letters and Position Statements while ensuring HIPAA compliance, case accuracy, and completeness.
• Manage appeals throughout the full case lifecycle by monitoring caseloads, tracking case progression, coordinating required next steps, and preparing cases for State Hearings.
• Maintain accurate case status updates within the State Hearing System (SHS), upload required documentation, route cases to appropriate business areas, and coordinate activities through written correspondence while ensuring compliance with all contractual timeliness and performance requirements.
• Serve as the primary point of contact for members upon receipt of a hearing request and following reevaluation, explaining appeal outcomes, hearing procedures, and addressing questions or concerns in a professional and customer-focused manner.

What we're looking for

• Extensive Knowledge of the Medi-Cal Dental criteria required. Must be able to read X-rays.
• Strong written and verbal communication skills.
• Excellent organization, analytical, and problem-solving abilities.
• Ability to manage multiple tasks and navigate several systems simultaneously.
• Proficiency with Microsoft Word and Excel.

What you should expect in this role

• Role requires reporting onsite 5 days a week for training ,and then will become Hybrid for special training requests, or other business needs. The office is in Roseville, Ca.
• The deadline to submit applications for this posting is October 25, 2026