Claims Suspense Supervisor - Hybrid - West Sacramento, CA

Summary

Gainwell Technologies is seeking an experienced Claims Suspense Supervisor to support claims operations for California’s Medi-Cal program.

In this role, you will lead a team responsible for researching, reviewing, and resolving suspended Medi-Cal claims to support accurate and timely claims adjudication. You will oversee daily operations, manage claims inventory, monitor team performance, and help ensure claims are processed in accordance with program requirements, policies, regulatory standards, and client service level agreements (SLAs).

This role requires a strong combination of claims operations knowledge and people leadership in a high-volume, metrics-driven environment.

Your role in our mission

• Supervise the daily operations of the Claims Suspense team, including workflow, staffing priorities, inventory, productivity, and quality.
• Monitor suspended claims inventories and help ensure claims are researched, reviewed, priced, adjudicated, and resolved within established turnaround times and SLAs.
• Ensure claims are processed accurately and consistently in accordance with Medi-Cal policies, regulatory requirements, reimbursement guidelines, and client procedures.
• Monitor employee performance against established quality, productivity, accuracy, and turnaround-time expectations.
• Lead and develop employees through coaching, training, feedback, performance management, and day-to-day operational support.
• Conduct quality reviews, identify trends and operational issues, and partner with leadership to improve claims processing, workflow, and overall team performance.

What we're looking for

• Three or more years of experience in healthcare operations, Medicaid/Medi-Cal, healthcare claims, claims adjudication, claims examination, or a related healthcare function.
• Five or more years of supervisory or leadership experience.
• Previous experience with claims suspense, claims examination, claims processing, or claims operations is strongly preferred.
• Knowledge of healthcare reimbursement methodologies, claims pricing, regulatory requirements, policies, and procedural guidelines.
• Strong leadership, analytical, problem-solving, and organizational skills with the ability to manage multiple priorities in a high-volume production environment.
• Strong written and verbal communication skills with proficiency in claims processing systems and Microsoft Office applications, particularly Excel.

What you should expect in this role

• This is a hybrid position that will primarily work remotely, with occasional in-office requirements at our West Sacramento, CA office based on business, operational, client, or leadership needs.
• Candidates must be able to report to the West Sacramento office when required.
• Standard work schedule is Monday through Friday, 7:00 AM to 4:00 PM.
• You will work in a fast-paced, metrics-driven claims environment requiring strong prioritization, attention to detail, and timely decision-making.
• You will be responsible for monitoring operational performance and supporting improvements related to claims adjudication, quality, productivity, and service levels.
• To work effectively as a teleworker with Gainwell, employees must have a broadband internet connection with a minimum speed of 24 Mbps download and 8 Mbps upload. Higher speeds are recommended for optimal performance.

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

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