Healthcare Claims Operations Manager (Jackson, MS)

Summary

The Healthcare Claims Operations Manager position will be responsible for the following functions: Mailroom, data capture, scanning, adjustments, resolution, clinical, and change orders related to State Medicaid Programs. The manager will be required to work with other managers for the rest of the organization in support of the Medicaid contract. The manager will lead the daily activities of supervisors in the acceptance, control, and processing of all functions in areas of responsibility.

This position is required to be onsite at the Jackson office in Jackson, Mississippi each day for work.

Your role in our mission

• Ability to lead a multiple functional organization with competing demands
• Ability to establish objectives and plans for the organization’s operations
• Ability to write reports, business correspondence, and procedures
• Ability to interpret reporting requirements and report to client all customer support activities in as glowing terms as and where possible
• Ability to effectively present information and respond to questions for groups of managers, customers, providers, investigative agencies, and the general public
• Ability to define problems, collect data, establish fact, and reach conclusions
• Ability to evaluate the performance of subordinates as well as assisting direct reports in the evaluation of their subordinates
• Ability to understand Medicaid procedures and policies
• Ability to work in the best interest of the company as a whole (i.e., team player) and not protect own territory
• Ability to effectively motivate performance and to manage workflow in an operations and production environment with established quality and quantity standards.
• Ability to understand claims processing in an automated environment
• Ability to maintain strong internal controls and work with auditing teams (internal and external) to meet client and Gainwell requirements
• Ability to meet established corporate leadership requirements on personnel, budgets, and processes
• Ability to create budgets, outlook, maintain budget, and work with direct reports to do the same
• Ability to maintain staffing levels as budgeted and fill billable direct positions quickly

What we're looking for

• Bachelor’s degree (BA or BS) required; RN degree is preferred, but not necessary.
• Excellent project management and planning skillswith the ability to communicate in writing as well as speak in front of groups required.
• Medicaid and customer service experience in a health care environment required
• Five (5) or more years of medical claims leadership preferred
• Strong skills in use of technology, mailroom processes (document/data processing), medical claims, and clinical functional areas.

What you should expect in this role

• This is a full-time permanent regular salaried (W-2) employee position.
  • Monday through Friday work schedule (40 hours per week).
• Health (medical, dental, vision) benefits start on day 1 of employment.
• Company match 401K and other benefits available within months of starting.
• New 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.
• This position requres being in the Jackson, Mississippi office during working hours.
• Video cameras must be used during all interviews, as well as during the initial week of orientation if hired.
• This position will remain posted until November 19, 2025, to take on applicantions.

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