Lead Claims Appeals for Medi-Cal

Gainwell Technologies; West Sacramento (CA); On-site; USD 47,000 - 67,000; Full time

Benefits offered by this job

Health benefits

401(k) match

Flexible vacation policy

Educational assistance

Job summary

Gainwell Technologies is seeking an experienced Claims Appeals Team Lead to support California’s Medi-Cal appeals operations from our West Sacramento office. You will coordinate daily provider appeals activities, guide Appeals Examiners, and drive quality and throughput to meet SLAs.

As a hands-on leader, you’ll monitor workflow, mentor staff, and participate in process improvements to enhance accuracy and provider experience.

Qualifications

• 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.

Responsibilities

• 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.

Skills

Healthcare claims experience

Team lead experience

Analytical skills

Job description

Gainwell Technologies is seeking an experienced Claims Appeals Team Lead to support California’s Medi-Cal appeals operations from our West Sacramento office. You will coordinate daily provider appeals activities, guide Appeals Examiners, and drive quality and throughput to meet SLAs.

As a hands-on leader, you’ll monitor workflow, mentor staff, and participate in process improvements to enhance accuracy and provider experience.