Medi-Cal Claims Team Lead | Hybrid Role

Gainwell Technologies; West Sacramento (CA); Ibrido; USD 36.000 - 51.000; Tempo pieno

Vantaggi offerti da questo lavoro

401(k) match

Health benefits

Educational assistance

Flexible vacation policy

Descrizione del lavoro

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

In this hands-on role you will provide day-to-day guidance and operational support to team members processing Conlan member reimbursement claims, serve as SME, help guide workflows, manage escalations and ensure work is completed accurately and in accordance with SLAs.

Competenze

• High school diploma or equivalent required.
• 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.

Mansioni

• 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.

Conoscenze

Customer service

Healthcare claims processing

Guidance / training

Analytical thinking

Formazione

High school diploma or equivalent

Descrizione del lavoro

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

In this hands-on role you will provide day-to-day guidance and operational support to team members processing Conlan member reimbursement claims, serve as SME, help guide workflows, manage escalations and ensure work is completed accurately and in accordance with SLAs.