Claims Suspense Team Lead

🔥 7 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $37.5k - $53.5k / year

⏰ Full Time

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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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

• Monitor suspended claims inventories and help prioritize aging claims to meet turnaround times and service level requirements • Review, research, price, process, and resolve suspended claims according to Medi-Cal guidelines, policies, and procedures • Provide day-to-day guidance, training, and operational support to Claims Examiners • Assist with complex claims and questions • Track team productivity, quality, claims inventory, and other operational metrics • Communicate potential issues or trends to the Claims Suspense Supervisor • Identify workflow, quality, and processing issues • Support improvements to claims accuracy, productivity, and operational performance • Serve as backup to the Claims Suspense Supervisor • Help coordinate daily team activities and priorities

🎯 Requirements

• Three or more years of experience in healthcare claims processing, claims adjudication, claims examination, claims suspense, Medicaid/Medi-Cal, or a related healthcare claims function • Experience researching and resolving suspended, pended, denied, or exception healthcare claims • Previous experience as a team lead, senior claims examiner, senior claims processor, or other position providing day-to-day guidance and support to team members is preferred • Knowledge of healthcare claims processing, claims policies and procedures, reimbursement or pricing guidelines, and healthcare or insurance terminology • Strong analytical and problem-solving skills • Excellent attention to detail and commitment to quality and accuracy • Strong communication and organizational skills • Ability to prioritize work and support a team in a fast-paced, metrics-driven claims environment • Broadband internet connection with a minimum speed of 24 Mbps download and 8 Mbps upload

🏖️ Benefits

• Work flexibility • Learning and career development • Flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies