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Gainwell Technologies develops digital and cloud-enabled solutions for the human services and public health ecosystem. The company works with clients across all 50 U.S. states on healthcare initiatives including Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions. Its work connects technology with public health delivery, healthcare administration, and efforts to improve health outcomes and community well-being.
Lead Medical Claims Research Analyst - California Hybrid
Lead medical claims research activities, guide analysts, and resolve complex provider, client, and operational inquiries. Support compliant healthcare operations and service improvements for Gainwell Technologies.
United States
California$70,000 – $80,000 / year
HybridFull-timeSeniorEnglish RequiredResearch AnalystDescription
- Lead the Research Analyst team through functional direction and daily support
- Handle complex inquiries, escalations, claims research, and related correspondence
- Research and resolve medical claims, provider, client, and operational inquiries ranging from routine to highly complex
- Partner with providers, clients, leadership, and cross-functional teams to address escalated issues
- Assist with program initiatives while meeting applicable compliance requirements
- Maintain knowledge resources and help establish effective practices
- Contribute to employee training and mentoring
- Record complex resolutions and operational guidance
- Assess operational trends and identify opportunities to improve processes
- Propose practical solutions that strengthen efficiency, service delivery, customer satisfaction, and business results
Requirements
- At least three years of experience in healthcare operations, medical claims processing, provider support, customer service, business process outsourcing, research, or a related area
- Experience with Medi-Cal or Medicaid is preferred
- Functional leadership experience with the ability to direct, coach, mentor, and support team members
- Strong capabilities in analysis, research, problem-solving, organization, and decision-making
- Excellent written, verbal, interpersonal, presentation, and facilitation abilities
- Ability to work effectively with providers, clients, leadership, and cross-functional teams
- Experience evaluating business processes, finding improvement opportunities, and creating practical solutions
- Working knowledge of healthcare regulations, provider operations, medical claims processing, customer support practices, and business systems for researching, tracking, and resolving inquiries
- Must live in California
- Access to reliable high-speed internet is required
Benefits
- Flexible work arrangements
- Opportunities for learning and career advancement
- Generous vacation policy with flexible use
- Employer-matched 401(k) plan
- Comprehensive healthcare coverage
- Educational assistance
- Leadership and technical development academies
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