Healthcare Claims Operations Manager

🕒 July 13

🤠 Texas – Remote

🤠 Texas – Remote

💵 $86.7k - $123.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

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👻 Ghost score 45%

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Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

📦 Logistics

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Consulting • Logistics • Healthcare Insurance

Gainwell Technologies is the nation’s leading provider of digital and cloud-enabled solutions across the human services and public health ecosystem. With a mission-driven approach, Gainwell serves clients in all 50 U. S. states, focusing on improving health outcomes and delivering intuitive, human-centered experiences. Their comprehensive suite of solutions includes Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions, all designed to advance the future of healthcare and enhance community well-being.

📋 Description

• Lead initiatives to optimize the end-to-end claims lifecycle, including mailroom intake and data entry • Reduce manual touches in claims adjudication and adjustment processing • Design and implement process standardization and best practices across institutional and professional claim streams • Develop and execute claims operations strategies to improve accuracy, turnaround time, and cost efficiency across Medicaid workflows • Analyze claims data, denial trends, and process steps to identify root causes, systemic issues, and improvement opportunities • Define business and technical requirements for 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 and data capture meet business and reporting needs • Support Design, Development and Implementation efforts aligned with enterprise standards and data requirements • Support governance, executive reporting, roadmap planning, and strategic initiatives • Drive continuous improvement using data analytics, process improvement methodologies, and automation opportunities • Establish and maintain operational playbooks and governance structures for claims processing and issue management

🎯 Requirements

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

🏖️ Benefits

• Work flexibility • Learning and career development • Technical credentials and certifications • Generous, flexible vacation policy • Educational assistance • Leadership and technical development academies • 401(k) employer match • Comprehensive health benefits • Quarterly travel for onsite team meetings

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