Remote Medical Claims Research Lead

Gainwell Technologies; California (MO); Remote; USD 70,000 - 80,000; Full time

Benefits offered by this job

Health benefits

401(k) employer match

Flexible vacation policy

Educational assistance

Leadership development academies

Job summary

Gainwell Technologies is seeking a Medical Claims Research Analyst Lead to guide a team of analysts in resolving complex claims research and provider inquiries. You will promote consistency, quality, and timely resolution while ensuring compliance with procedures and regulations.

You will collaborate with providers, clients, and cross-functional partners to resolve escalated issues, contribute to knowledge resources, and mentor staff.

Qualifications

• Three or more years of experience in healthcare operations, medical claims processing, provider support, customer service, or related fields.
• Medi-Cal or Medicaid experience preferred.
• Demonstrated leadership and ability to guide a team in a fast-paced environment.

Responsibilities

• Provide functional leadership and day-to-day guidance to the Research Analyst team, supporting complex inquiries and claims research.
• Investigate and resolve routine to highly complex medical claims and provider inquiries using established policies.
• Collaborate with providers, clients and cross-functional teams to resolve escalated issues and ensure compliance.
• Develop best practices, mentor staff, and document complex issue resolution and operational guidance.
• Identify opportunities to improve efficiency, service delivery, and customer satisfaction.

Skills

Healthcare operations

Medical claims processing

Provider support

Analytical skills

Job description

Gainwell Technologies is seeking a Medical Claims Research Analyst Lead to guide a team of analysts in resolving complex claims research and provider inquiries. You will promote consistency, quality, and timely resolution while ensuring compliance with procedures and regulations.

You will collaborate with providers, clients, and cross-functional partners to resolve escalated issues, contribute to knowledge resources, and mentor staff.