Remote Claims Suspense Lead – Medi-Cal

RemoteFetch; West Sacramento (CA); Remote; USD 38,000 - 54,000; Full time

Job summary

Gainwell Technologies is seeking an experienced Claims Suspense Team Lead to support California's Medi-Cal program. This remote role leads a team of Claims Examiners, prioritizes suspended claims, and ensures timely review, pricing, and resolution in accordance with Medi-Cal guidelines.

The successful candidate will mentor staff, monitor productivity and quality metrics, and collaborate with the supervisor to optimize workflows in a fast-paced, compliance-driven environment.

Qualifications

• 3+ years in healthcare claims processing or related function.
• Experience researching and resolving suspended, pended, denied, or exception claims.
• Previous experience as a team lead or senior examiner preferred.
• Knowledge of claims policies, reimbursement guidelines, and insurance terminology.
• Strong analytical, detail-oriented, and quality-focused.
• Strong communication and organizational skills in a fast-paced, metrics-driven environment.

Responsibilities

• Monitor suspended claims inventories and prioritize aging claims to meet turnaround times and service levels.
• Support review, research, pricing, processing, and resolution of suspended claims per Medi-Cal guidelines.
• Provide day-to-day guidance, training, and operational support to Claims Examiners.
• Track productivity, quality, claims inventory, and other metrics; report trends to the supervisor.
• Identify workflow, quality, and processing issues and support performance improvements.
• Serve as a backup to the Claims Suspense Supervisor and coordinate daily team activities.

Skills

Healthcare claims processing

Team leadership

Analytical skills

Communication skills

Job description

Gainwell Technologies is seeking an experienced Claims Suspense Team Lead to support California's Medi-Cal program. This remote role leads a team of Claims Examiners, prioritizes suspended claims, and ensures timely review, pricing, and resolution in accordance with Medi-Cal guidelines.

The successful candidate will mentor staff, monitor productivity and quality metrics, and collaborate with the supervisor to optimize workflows in a fast-paced, compliance-driven environment.