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Operation CIF Lead - Roseville, CA - Hybrid

Date:  Feb 1, 2024

Roseville, CA, US, 95747-6645

Req ID:  21160

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. 



As an Operation Specialist Lead at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges.

Your role in our mission

•    Assists with maintaining and updating department procedures, training documents, and materials to ensure that company administrative needs are met.
•    Provides training, coaching, and mentorship.
•    Produce and distribute reports.
•    Identify process efficiencies with workflow.
•    Evaluate dental
claims, adjustments, and prior authorization requests against Medi-Cal Dental criteria.
•    Generate requests to dental providers for missing
claims information.
•    Confirm that
claims documentation is complete, complies with policy, and refer documents to dental professionals when required.
•    Analyzes and evaluates both production and processing output results to identify errors and inconsistencies.
•    Works with and consults DHCS staff to review and evaluate inconsistent and erroneous output results.
•    Evaluates program policy changes and identifies potential adverse impact(s) on systems and operations prior to implementation.
•    Identifies and confirms the need for system modifications or improvements.
•    Analyzes and proposes alternatives to potential system changes; performs EPC processing as requested.

What we're looking for

•    Two years of college preferred or equivalent combination of education and experience; two years of full-time experience supporting operations of the Medi-Cal/Denti-Cal.
•    Strong leadership skills.
•    Analytical skills necessary to effectively evaluate operations test results.
•    Ability to communicate effectively and to work independently as well as collaboratively.
•    Serves as a point of escalation for complex claims issues; ability to maintain confidentiality.


What you should expect in this role

  • Must be a resident of the state of California.
  • Hybrid work environment 3 days a week in the office as needed for face-to-face and client meetings with the remainder of time remote work.  The office is located in Roseville, CA.


The pay range for this position is $69,100.00 - $98,700.00 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 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.

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