Gainwell Technologies dezvoltă soluții digitale și soluții bazate pe cloud pentru ecosistemul serviciilor sociale și al sănătății publice. Compania colaborează cu clienți din toate cele 50 de state ale SUA în cadrul unor inițiative de sănătate, inclusiv modernizarea Medicaid Enterprise, analiza datelor, serviciile pentru furnizori și soluțiile farmaceutice. Activitatea sa conectează tehnologia cu furnizarea serviciilor de sănătate publică, administrarea serviciilor medicale și eforturile de îmbunătățire a rezultatelor în materie de sănătate și a bunăstării comunităților.
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.
Descriere
- 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
Cerințe
- 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
Beneficii
- 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