Medi-Cal Claims Appeals Lead

Gainwell Technologies; West Sacramento (CA); Sur place; USD 59 000 - 85 000; Plein temps

Avantages offerts par ce poste

Generous, flexible vacation policy

401(k) employer match

Comprehensive health benefits

Educational assistance

Leadership and technical development

Résumé du poste

Gainwell Technologies is seeking an experienced Claims Appeals Supervisor to support California’s Medi-Cal program at our West Sacramento office. You will supervise the daily operations of a team reviewing and adjudicating provider appeals, ensuring timely responses and compliance with requirements.

You’ll lead Appeals Examiners, monitor performance, address escalations, and partner with clients to improve quality, productivity, and turnaround times in a fast-paced, onsite environment.

Qualifications

• Three or more years of experience in healthcare operations, healthcare claims, claims appeals, or a related function.
• Five or more years of supervisory or people leadership experience.
• Experience managing operational performance through KPIs, SLAs, productivity, quality, turnaround-time, or backlog metrics.
• Strong analytical and problem-solving skills with ability to interpret data and drive improvements.
• Strong written and verbal communication skills with stakeholders.

Responsabilités

• Supervise day-to-day provider appeals operations, including workflow, staffing priorities, productivity, quality, and turnaround times.
• Oversee review and adjudication of provider appeals for accurate, timely resolution per policies and procedures.
• Ensure adherence to SOPs, regulatory requirements, SLAs, and client performance standards.
• Lead, coach, train, and develop Appeals Examiners and staff while managing performance.
• Monitor performance metrics and implement action plans to improve outcomes.
• Analyze appeal trends and partner with clients to reduce provider appeals and improve performance.

Connaissances

Healthcare operations experience

People leadership

Analytical thinking

Written and verbal communication

Time management

Description du poste

Gainwell Technologies is seeking an experienced Claims Appeals Supervisor to support California’s Medi-Cal program at our West Sacramento office. You will supervise the daily operations of a team reviewing and adjudicating provider appeals, ensuring timely responses and compliance with requirements.

You’ll lead Appeals Examiners, monitor performance, address escalations, and partner with clients to improve quality, productivity, and turnaround times in a fast-paced, onsite environment.