Claims Operations Manager

Date: Feb 21, 2025

Location:

Atlanta, GA, US, 30084

Req ID: 28874

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development.

Summary

Seeking a experienced Claims Operations Manager to lead 2 provider teams, one claims adjudication team and mailroom operations . The individual will have a strong background in Claims Processing and experience with Medicaid Management Systems (MMIS).

The successful candidate should be able to interact and direct their supervisors and their reports on day-to-day activities, manage Service Level Contractual Requirements, cooperatively work with other operational leaders with effective communication and able to innovate and develop solutions effectively.

Your role in our mission

SME on Claims Operations and MMIS Operations.
Ability to work effectively with direct reports and various account stakeholders including but not limited to effective communication and presentation skills.
Ability to manage Account Service Level Requirements.
Take Responsibility of cost budget items related to Operational Departments being managed.
Demonstrate effective Communication Skills with Clients and Vendors
Demonstrate ability to innovate and interact with change management efforts as prescribed by stakeholders and the corporation.
Can't have an existing family member working with GA MMIS account.

What we're looking for

Bachelor’s degree.
Strong executive presence and excellent written and oral communication skills to build relationships and interact with clients and team members.
Skilled in managing projects, financial budgets, and forecasting.
A minimum of four (4) years’ experience managing claims processing operations and personnel for a government or private sector health care payor.
A minimum of two (2) years MMIS experience.

What you should expect in this role

Opportunities to travel through your work (0-10%)
This is a full-time permanent regular salaried (W-2) employee position.
- Selected employee will be required to work in our office in Tucker, GA.
- Monday through Friday work schedule.
Health (medical, dental, vision) benefits start on day 1 of employment.
Company match 401K and other benefits available within months of starting.
Employees are eligible to take advantage of flexible vacation policy after ninety (90) calendar days of employment. Any exception requires manager approval prior to employee's Gainwell start date.
Company provided computer for work use.
Video cameras must be used during all interviews, as well as during the initial week of orientation if hired.
We will accept applications for this position until March 1, 2025, or until it is filled.

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The pay range for this position is $120,000 - $130,000 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.