Claims Adjudication Manager - 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 Claims Adjudication Manager 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. Gainwell empowers you to help clients deliver better health and human services outcomes using innovative technology and solutions, enabling you to design your career for growth, new possibilities, and refinement of your valuable skills. Here are the details on this position.

Your role in our mission

• Manages healthcare claims processing operations, overseeing the receipt, processing, calculation, payment, reporting, and associated administrative activities of claims submitted by members and/or providers to ensure compliance with contractual requirements, laws, regulations, and proper claims policies and procedures. Contributes to business and operational strategy of the business process outsourcing area to optimize profitability and client satisfaction as well as meet corporate objectives and goals.

• Oversees processing of claims, resubmissions, and adjustments. Assists adjudicators in resolution of complex claims and associated issues.

• Assumes supervisory responsibility for electronic and paper claims submissions; oversees analysis and resolution of member, provider, and procedure edits/audits and errors, and maintains knowledge of coding and reimbursement requirements for compliance with local, state, and federal regulations.

• Interacts regularly with the customer and resolves complex client problems and disputes in a professional manner. Serves as an escalation point for customer concerns.

• Coaches and evaluates assigned staff on performance expectations, establishing priorities, setting and achieving goals, and assists in the identification and coordination of training needs.

What we're looking for

• Must have four (4) years of experience in a claim processing setting.

• Must have government healthcare or private sector healthcare payer experience in the processing of Medicaid claims.

• Proven leadership ability with two (2) years of experience in leading people required.

• Strong communication skills for interacting with personnel and strong interpersonal, time management, and organizational skills.

• Strong attention to detail and the ability to multi-task and prioritize work to meet corporate, client, contractual, and SLA deadlines.

What you should expect in this role

• Must be a resident of the state of California.

• Hybrid work environment 1-2 days a week in the office as needed for face-to-face and client meetings with the remainder of time remote work. The office is located in the Roseville/Sacramento area.

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The pay range for this position is $97,500.00 - $139,300.00 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.