Healthcare Claims Operations Manager - Madison, WI

Date: Sep 12, 2025

Location:

Madison, WI, US, 53784-0001

Req ID: 32063

Work Mode: Full-Time onsite (5+ days per week)

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.

Summary

Gainwell Technologies is seeking a Healthcare Claims Operations Manager to lead our Wisconsin Medicaid mailroom and claims intake operations. In this critical role, you will oversee the end-to-end processing of Medicaid-related mail and electronic claims documents, ensuring accurate data capture, timely adjudication, and compliance with state and federal program requirements. You will partner with cross-functional teams to drive process improvement, monitor KPIs, and deliver best-in-class operational outcomes.

Your role in our mission

As our Healthcare Claims Operations Manager, you will:

Lead Operations: Oversee daily mailroom and claims intake workflows, including scanning, document imaging, data entry, routing, and exception management to support Medicaid claim processing.
Manage Team: Lead a team of 15+ FTEs, setting clear performance objectives, monitoring results, and coaching for development.
KPI Ownership: Track and improve key operational metrics, including turnaround time, accuracy/adjudication rates, claim backlog and aging, and compliance with SLAs.
Process Improvement: Collaborate with Claims, IT, and Compliance teams to streamline workflows, remove bottlenecks, implement change orders, and lead root-cause analysis initiatives.
Compliance & Audit: Ensure strict adherence to internal controls, HIPAA/PHI requirements, and quality standards; partner with audit teams to prepare for and support compliance reviews.
Resource Planning: Manage staffing schedules, workload distribution, and budget planning to meet or exceed service levels while controlling operational costs.

What we're looking for

Education & Experience: Bachelor’s degree (BA/BS) or equivalent experience, plus 5+ years of leadership experience in healthcare claims operations, Medicaid processing, mailroom management, or revenue cycle management.
Team Leadership: Proven success managing a team of 15+ FTEs in a high-volume, production-driven environment, with strong coaching and performance management skills.
Operational Expertise: Deep understanding of Medicaid claims processing, adjudication standards, compliance requirements, and mailroom/document intake workflows.
Data-Driven Decision Making: Skilled in tracking, analyzing, and improving KPIs such as turnaround time, accuracy, backlog/aging, and SLA compliance.
Technical Proficiency: Advanced use of document management systems, claims adjudication tools, and Microsoft Office (Excel, Word, Outlook).
Preferred Qualification: Professional coding experience (CPC or equivalent) is a plus but not required.

What you should expect in this role

Onsite role based in Madison, WI — in a fast-paced, production-driven environment directly impacting Medicaid claim turnaround.
Opportunity to collaborate closely with claims, IT, compliance, and audit teams to deliver operational excellence.
Clear career progression path, with regular performance reviews and leadership development opportunities.
A supportive, mission-driven team environment that values accuracy, transparency, and continuous learning.

The pay range for this position is $79,000.00 - $112,900.00 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 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), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.