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. Youll 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 communitys most vulnerable.

Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcares 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

LI-HYBRID

LI-CB1

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. Youll 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 , and educational assistance.

We also have a variety of leadership and technical development academies to help build your skills and capabilities.