Remote Medicaid Claims Operations Leader

Gainwell Technologies; Texas; Remote; USD 87,000 - 124,000; Full time

Benefits offered by this job

Generous vacation policy

401(k) employer match

Comprehensive health benefits

Educational assistance

Leadership and technical development

Job summary

Gainwell Technologies is seeking a Healthcare Claims Operations Manager to lead end-to-end Medicaid claims processing improvements, including mailroom intake, data entry, and adjudication workflows. The role demands cross-functional collaboration with Operations, Compliance, IT, and clients to ensure compliant, timely processing and enhanced provider and member experiences.

The ideal candidate has 5+ years in Medicaid operations, strong data analytics skills with Excel/Power BI, and proven

Qualifications

• Five or more years of experience in Medicaid operations, claims management, mailroom intake operations, or business analysis.

Responsibilities

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

Skills

Medicaid operations

Data analysis

Stakeholder management

Power BI

Excel

Tools

Power BI

Excel

Job description

Gainwell Technologies is seeking a Healthcare Claims Operations Manager to lead end-to-end Medicaid claims processing improvements, including mailroom intake, data entry, and adjudication workflows. The role demands cross-functional collaboration with Operations, Compliance, IT, and clients to ensure compliant, timely processing and enhanced provider and member experiences.

The ideal candidate has 5+ years in Medicaid operations, strong data analytics skills with Excel/Power BI, and proven