Claims Appeals Team Lead - Onsite - West Sacramento, CA

Summary

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

In this role, you will coordinate and support daily provider appeals operations to help ensure appeals are processed accurately, timely, and in accordance with established policies, regulatory requirements, and service-level expectations.

Working under the direction of the Claims Appeals Supervisor, you will serve as a primary resource for Appeals Examiners, help coordinate daily workflow, provide training and guidance, monitor quality and performance, and assist with complex appeals and operational issues.

Your role in our mission

• Coordinate daily provider appeals activities and help prioritize workloads to meet established turnaround times and service-level requirements.
• Provide day-to-day guidance, training, and operational support to Appeals Examiners and other team members.
• Review provider appeals for accuracy, completeness, and compliance with established policies, procedures, and departmental standards.
• Assist with quality assurance activities, identify processing issues or trends, and support corrective actions when needed.
• Track productivity, quality, turnaround times, inventory, and other performance metrics and provide status updates to leadership.
• Support process improvements designed to increase efficiency, improve accuracy, reduce operational issues, and enhance the provider experience.

What we're looking for

• Three or more years of experience in healthcare claims, appeals and grievances, provider appeals, Medicaid/Medi-Cal, or a related healthcare function.
• Experience reviewing, researching, processing, or resolving healthcare claims or provider appeals.
• Previous experience as a team lead, senior claims examiner, senior appeals examiner, or in a role providing day-to-day guidance and support to other employees is preferred.
• Strong analytical and critical-thinking skills with excellent attention to detail and a commitment to quality and accuracy.
• Ability to train, coach, and support team members while helping coordinate workflow in a high-volume environment.
• Strong written and verbal communication skills with the ability to organize priorities and meet established deadlines.

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.
• Standard work schedule is Monday through Friday, 6:00 AM to 2:30 PM.
• You will work in a fast-paced, metrics-driven healthcare appeals environment requiring strong prioritization, accuracy, and timely decision-making.
• This is a hands-on lead role that requires supporting Appeals Examiners while helping monitor daily workflow, quality, productivity, and turnaround times.

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

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