Remote Medicaid Claims Operations Leader

Gainwell Technologies LLC; Columbus (OH); Remote; USD 87,000 - 124,000; Full time

Benefits offered by this job

401(k) match

Health benefits

Educational assistance

Generous vacation policy

Leadership academies

Job summary

Gainwell Technologies LLC in Columbus, OH is seeking a Manager, Service Delivery – CEF Center of Excellence to lead end-to-end Medicaid claims operations and optimize processes to meet CMS and state requirements. This role focuses on improving accuracy, speed, and provider/member experience while reducing manual effort.

You will collaborate with Operations, Compliance, IT and clients to standardize processes, develop dashboards and KPIs, and drive data-driven improvements across Medicaid

Qualifications

• Five or more years of Medicaid operations or claims management experience.
• Strong analytical and problem-solving skills with data interpretation.
• Experience leading cross-functional initiatives across operations, compliance, IT.
• Knowledge of CMS guidelines and Medicaid workflows.
• Excellent communication and stakeholder management.

Responsibilities

• Lead end-to-end claims lifecycle optimization across mailroom, data entry, and adjudication.
• Define process standardization across claim streams.
• Develop and execute claims operations strategies to improve accuracy and efficiency.
• Analyze claims data and denial trends to identify root causes.
• Define business and technical requirements for mailroom and claims operations.
• Develop reporting frameworks, dashboards, KPI structures.
• Partner with product and engineering to align systems and data capture.
• Support governance, executive reporting, and strategic initiatives.
• Drive continuous improvement using data analytics and automation.
• Establish and maintain operational playbooks and governance.

Skills

Medicaid operations

Claims management

Mailroom intake

Business analysis

Analytical skills

Excel

Power BI

Tools

Excel

Power BI

Job description

Gainwell Technologies LLC in Columbus, OH is seeking a Manager, Service Delivery – CEF Center of Excellence to lead end-to-end Medicaid claims operations and optimize processes to meet CMS and state requirements. This role focuses on improving accuracy, speed, and provider/member experience while reducing manual effort.

You will collaborate with Operations, Compliance, IT and clients to standardize processes, develop dashboards and KPIs, and drive data-driven improvements across Medicaid