Remote Claims Suspense Lead – Medi-Cal Operations

Gainwell Technologies LLC; West Sacramento (CA); Hybrid; USD 85,000 - 121,000; Full time

Job summary

Gainwell Technologies is seeking a seasoned Claims Suspense Manager to lead Med-Cal claims suspension operations in California. You will guide supervisors, manage inventory and performance, and ensure compliance with contracts, policies, and SLAs.

You will report to West Sacramento in a hybrid setup, collaborate with clients and leadership, and drive continuous improvement across the claims operation. The role requires strong leadership and healthcare claims knowledge to deliver quality outcomes.

Qualifications

• Bachelor's degree or equivalent; preferred in business, insurance, healthcare admin.
• 9+ years in healthcare claims or related operations.
• 5+ years in leadership/supervisory roles.
• Experience with KPIs, SLAs, budgets, and client relationships.

Responsibilities

• Lead and manage Claims Suspense operations to meet service levels.
• Oversee claims and appeals processing, inventory, and quality.
• Develop supervisors; foster accountability and continuous improvement.
• Monitor KPIs/SLAs; identify trends and implement improvements.
• Partner with clients and leaders to resolve challenges and deliver outcomes.
• Improve processing efficiency and reduce appeals through initiatives.

Skills

Leadership

Healthcare claims

KPIs & SLAs

Communication

Problem-solving

Project management

Education

Bachelor's degree

Healthcare administration

Job description

Gainwell Technologies is seeking a seasoned Claims Suspense Manager to lead Med-Cal claims suspension operations in California. You will guide supervisors, manage inventory and performance, and ensure compliance with contracts, policies, and SLAs.

You will report to West Sacramento in a hybrid setup, collaborate with clients and leadership, and drive continuous improvement across the claims operation. The role requires strong leadership and healthcare claims knowledge to deliver quality outcomes.