Remote Medicaid Claims Operations Manager

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

Job summary

Gainwell Technologies LLC in the United States is seeking a Manager, Service Delivery – CEF Center of Excellence to lead strategies that drive operational excellence across Medicaid claims processing, including mailroom, data entry, and claims issue resolution.

You will partner with Operations, Compliance, IT, and clients to embed standardized, data-driven processes, ensure regulatory alignment, and deliver measurable performance improvements through planning, execution, and governance.

Qualifications

• Five (5) or more years of experience in Medicaid operations, claims management, mailroom intake operations, or business analysis.
• Strong analytical and problem-solving skills with the ability to interpret claims data and drive insights.
• Experience with data and reporting tools (e.g., Excel, Power BI) and applying insights to improve operations.
• Proven ability to lead cross-functional initiatives across operations, compliance, and IT in a healthcare payer environment.
• Knowledge of Medicaid claims processing, CMS guidelines, and coordination of benefits workflows.
• Excellent communication and stakeholder management skills, with experience influencing senior leadership.

Responsibilities

• Lead initiatives to optimize end-to-end claims lifecycle, including mailroom intake, data entry, and adjudication.
• Design and implement process standardization and best practices across claim streams.
• Develop and execute claims operations strategies to improve accuracy, turnaround time, and cost efficiency.
• Analyze claims data and denial trends to identify root causes and opportunities for improvement.
• Define business and technical requirements to support mailroom and claims operations, systems, workflows, and compliance.
• Develop reporting frameworks, dashboards, and KPI structures to drive operational visibility and performance.
• Partner with product and engineering teams to ensure systems meet business and reporting needs.
• Support governance, executive reporting, roadmap planning, and strategic initiatives.
• Drive continuous improvement initiatives using data analytics, process improvement methodologies, and automation opportunities.

Skills

Medicaid operations

Data analysis

Cross-functional collaboration

Stakeholder management

Tools

Excel

Power BI

Job description

Gainwell Technologies LLC in the United States is seeking a Manager, Service Delivery – CEF Center of Excellence to lead strategies that drive operational excellence across Medicaid claims processing, including mailroom, data entry, and claims issue resolution.

You will partner with Operations, Compliance, IT, and clients to embed standardized, data-driven processes, ensure regulatory alignment, and deliver measurable performance improvements through planning, execution, and governance.