Adjudication Lead - Roseville, CA (Hybrid)

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development.

Summary

As a Adjudication Lead - Roseville, CA (Hybrid) at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve - a community's most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare's biggest challenges. Here are the details on this position.

Your role in our mission

• Answers questions from the claims adjudication team and responds to highly complex customer questions and/or forwards items to appropriate personnel.

• Research customer inquiries and responds to appropriate parties in a timely manner.

• Processes requests and updates account history with results of inquiry to include proper documentation.

• Processes and distributes incoming and outgoing work for multiple teams in accordance with established service level agreements.

• Performs data entry and matches documents to appropriate accounts to ensure up to date and accurate information.

• Interfaces with team members, management, and customers in reference to claim adjudication issues.

• Reviews client reports on a daily basis to ensure data integrity; prepares and submits report to management.

• Reviews and recommends modifications to procedures and workflow as necessary to ensure efficient and effective processing of transactions.

• Monitors daily transactions of claims to ensure policy and procedures are in accordance with service level agreement.

• Assists supervisor/manager with the day-to-day operations of the claims adjudication area, including training and/or mentoring less experienced staff.

What we're looking for

• High school diploma or G.E.D.

• Three or more years of Claims, TARs, CIFs. NOAs, RTDs experience

• Experience working with organizational functions and personnel

• Experience working with, computer software, and CRM technology, and Mainframe

• Experience working with and skilled in the use of help desk software

What you should expect in this role

• Hybrid office environment with 2 days in office, located in Roseville CA

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The pay range for this position is $44,800 - $64,000 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You'll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You'll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.