Claims Suspense Team Lead - Remote CA

Summary

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

In this role, you will serve as a primary resource for the Claims Suspense team, helping ensure suspended Medi-Cal claims are reviewed, researched, priced, and resolved accurately and timely. You will support the Claims Suspense Supervisor in coordinating daily workflow, monitoring claims inventory, and helping the team achieve established quality, productivity, and turnaround-time expectations.

You will also provide day-to-day guidance, training, and support to Claims Examiners while helping ensure claims are processed in accordance with Medi-Cal requirements, established procedures, and Gainwell service standards.

Your role in our mission

• Monitor suspended claims inventories and help prioritize aging claims to ensure established turnaround times and service level requirements are met.
• Support the review, research, pricing, processing, and resolution of suspended claims in accordance with Medi-Cal guidelines, policies, and established procedures.
• Provide day-to-day guidance, training, and operational support to Claims Examiners, including assisting with complex claims and questions.
• Track team productivity, quality, claims inventory, and other operational metrics and communicate potential issues or trends to the Claims Suspense Supervisor.
• Help identify workflow, quality, and processing issues and support efforts to improve claims accuracy, productivity, and operational performance.
• Serve as a backup to the Claims Suspense Supervisor as needed and help coordinate daily team activities and priorities.

What we're looking for

• Three or more years of experience in healthcare claims processing, claims adjudication, claims examination, claims suspense, Medicaid/Medi-Cal, or a related healthcare claims function.
• Experience researching and resolving suspended, pended, denied, or exception healthcare claims.
• Previous experience as a team lead, senior claims examiner, senior claims processor, or other position providing day-to-day guidance and support to team members is preferred.
• Knowledge of healthcare claims processing, claims policies and procedures, reimbursement or pricing guidelines, and healthcare or insurance terminology.
• Strong analytical and problem-solving skills with excellent attention to detail and a commitment to quality and accuracy.
• Strong communication and organizational skills with the ability to prioritize work and support a team in a fast-paced, metrics-driven claims environment.

What you should expect in this role

• This is a remote position supporting California’s Medi-Cal program.
• Standard work schedule is Monday through Friday, 7:00 AM to 3:30 PM.
• You will work in a fast-paced, metrics-driven claims environment requiring strong prioritization, accuracy, and timely decision-making.
• This is a hands-on lead role that requires supporting Claims Examiners while also helping monitor daily workflow, inventory, quality, and productivity.
• 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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