Medical Operations Claims Recovery Team Lead (Work From Home Any City, USA)

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

We are seeking a dynamic and experienced Training and Quality Assurance Team Lead to join our team. The ideal candidate will possess a comprehensive understanding of training methodologies, quality assurance procedures, and claims processing guidelines.

This individual will be responsible for overseeing the training programs for new hires as well as conducting refresher training sessions for existing staff.

Additionally, the Training and Quality Assurance Team Lead will play a pivotal role in developing training content, including videos, standard operating procedures (SOPs), and other documentation to ensure consistency and accuracy across the organization.

Your role in our mission

• Lead and coach claims recovery collectors to make contact with carriers and providers in order to drive document and payments recoveries on behalf of our clients
• Perform regular quality checks based on metrics and performance data
• Conduct audits of claims processing to ensure adherence to quality standards and regulatory requirements as requested by leadership
• Handle escalated calls from more junior team members as the initial point of contact and be the subject matter expert for a team of Operations agents
• Act as back up for supervisor as needed
• Confer with carriers by telephone or use Web sites to determine member eligibility and claim status
• Assess denials, pursue appeals or close claims when appropriate
• Update case management system with proper noting of actions and appeal / denial information
• Respond to carrier telephone, fax and e-mail inquiries regarding outstanding claims
• Sort and file correspondence
• Mail form letters to carriers to affect payment of outstanding claims
• Contact providers to obtain additional information and / or documentation to resolve unpaid claims
• Responsible for achieving high recoveries against a portfolio of claims
• Work with document imaging system for processing purposes
• Ensure that payers adhere to laws regarding timely filing of claims.
• Assist in pursuit of outstanding accounts to reach maximum reimbursement by working with finding resolutions for the tam’s most challenging claims and carriers.
• Required to meet more stringent fiscal and daily work event goals.
• Query databases to ensure inventory is prioritized correctly
• Run SQL to generate basic reports
• Report on team functions, quality, and throughput metrics
• Assist with creation and presentation of team PowerPoints
• Stay updated on industry trends and best practices in training and quality assurance

What we're looking for

• Minimum of 3-5 years of experience in medical claims processing, preferably in the specify industry
• In-depth knowledge of training methodologies, quality assurance procedures, and claims processing guidelines
• Strong communication and interpersonal skills, with the ability to effectively convey complex information to diverse audiences
• Proven experience in developing training content, including videos, SOPs, and other documentation
• Excellent organizational skills with the ability to manage multiple projects simultaneously
• Detail-oriented with a focus on accuracy and precision
• Ability to work independently as well as collaboratively in a team environment
• Proficiency in relevant software applications (e.g., Microsoft Office Suite, learning management systems, etc.)

What should you expect in this role

Remote any city, USA

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The pay range for this position is $46,900.00 - $67,000.00 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.