Medi-Cal Conlan Team Lead - Hybrid - West Sacramento, CA

Summary

Gainwell Technologies is seeking an experienced Medi-Cal Conlan Team Lead to support California’s Medi-Cal program and Conlan operations.

In this role, you will provide day-to-day guidance and operational support to team members responsible for processing Conlan member reimbursement claims. You will serve as a subject matter expert (SME), help guide team workflows, support complex cases and escalations, and help ensure work is completed accurately and in accordance with established requirements and service level agreements (SLAs).

This is a hands-on lead role that combines Conlan case processing with team support, workflow coordination, research, reporting, and problem resolution.

Your role in our mission

• Research and process Conlan member reimbursement claims in accordance with established Court Order requirements, policies and procedures, and SLA standards.
• Provide day-to-day guidance and operational support to team members, including answering process-related questions and assisting with complex cases.
• Help guide and review team workflows to support established productivity, quality, accuracy, and service-level expectations.
• Review member reimbursement requests, including incomplete requests, approvals, and denials, for completeness, accuracy, and compliance with applicable requirements.
• Collaborate with team members, leadership, clients, and customers to research and resolve claim-related issues, member cases, and escalations.
• Assist the Supervisor and senior leadership with claim research, operational reporting, workflow priorities, special projects, and other assignments.

What we're looking for

• High school diploma or equivalent.
• Two or more years of experience in customer service, healthcare, healthcare claims, member services, provider services, medical reimbursement, or related healthcare operations.
• Experience providing guidance, training, workflow support, or subject matter expertise to other employees preferred.
• Experience researching, reviewing, processing, or resolving healthcare claims, reimbursement requests, member cases, or similar healthcare transactions preferred.
• Ability to follow detailed policies, procedures, Court Order requirements, and established operational protocols.
• Strong analytical, critical-thinking, problem-solving, organizational, and communication skills with excellent attention to detail.

What you should expect in this role

• This is a hybrid position that is primarily remote with occasional in-office requirements at our West Sacramento, CA office.
• You must be able to report to the West Sacramento office as required based on business, client, or leadership needs.
• You will work in a customer-focused, metrics-driven healthcare operations environment with established productivity, quality, accuracy, and SLA expectations.
• This is a hands-on Team Lead role that requires supporting team members while also researching and processing Conlan member reimbursement cases.
• You will serve as a subject matter resource and assist with complex cases, escalations, workflow priorities, reporting, and special projects.
• You will handle confidential member, client, and company information in accordance with applicable privacy, security, and regulatory requirements.

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

#LI-HYBRID

#LI-MA1