Claims Appeals Supervisor - Onsite - West Sacramento, CA

Summary

Gainwell Technologies is seeking an experienced Claims Appeals Supervisor to support operations for California’s Medi-Cal program at our West Sacramento office.

In this role, you will oversee the daily operations of a team responsible for reviewing and adjudicating provider appeals, helping ensure accurate and timely responses in accordance with program requirements, regulatory standards, and established service levels.

You will provide direct leadership to Appeals Examiners and support staff, monitor operational performance, address escalations, and partner with clients and internal stakeholders to improve quality, productivity, turnaround times, and the overall appeals process.

Your role in our mission

• Supervise day-to-day provider appeals operations, including workflow, inventory, staffing priorities, productivity, quality, and turnaround times.
• Oversee the review and adjudication of provider appeals and help ensure accurate and timely resolution in accordance with established policies and procedures.
• Ensure adherence to standard operating procedures (SOPs), regulatory requirements, service level agreements (SLAs), and client-specific performance standards.
• Lead, coach, train, and develop Appeals Examiners and support staff while managing employee performance and supporting team development.
• Monitor operational performance, including productivity, accuracy, turnaround times, backlog levels, and other key performance indicators, and implement action plans when improvement is needed.
• Analyze appeal trends, identify root causes, and partner with clients and internal stakeholders to identify opportunities to reduce provider appeals and improve operational performance.

What we're looking for

• Three or more years of experience in healthcare operations, healthcare claims, claims appeals, provider services, Medicaid/Medi-Cal, or a related healthcare function.
• Five or more years of supervisory or people leadership experience, including responsibility for coaching, developing, and managing employee performance.
• Experience managing operational performance through KPIs, SLAs, productivity, quality, turnaround-time, or backlog metrics.
• Strong analytical and problem-solving skills with the ability to interpret operational data, identify trends, and drive process improvements.
• Strong written and verbal communication skills with the ability to work effectively with employees, clients, leadership, and internal stakeholders.
• Ability to manage multiple priorities, meet deadlines, and lead employees in a fast-paced, high-volume, metrics-driven environment.

What you should expect in this role

• This is a 100% onsite position at our West Sacramento, CA office. Remote or hybrid work is not available for this role.
• You will lead employees supporting provider appeals for California’s Medi-Cal program.
• You will work in a fast-paced, high-volume environment with responsibility for productivity, quality, turnaround times, backlog management, and service-level performance.
• This position requires regular interaction with employees, clients, leadership, and other internal stakeholders.
• You will be responsible for coaching, developing, and managing employees while supporting operational and process improvements.

This posting is being used to build a pipeline of qualified candidates for current and future opportunities.

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