Adjudication Lead - Roseville, CA (Hybrid)

Gainwell Technologies LLC•Roseville, CA

3d•$70,304 - $76,000•Hybrid

About The Position

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development. 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.

Requirements

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

Responsibilities

Answers questions from the claims adjudication team and responds to complex customer inquiries or routes them to the appropriate personnel.
Researches and responds to customer inquiries in a timely manner.
Processes requests and updates account history with proper documentation.
Processes and distributes incoming and outgoing work in accordance with service level agreements.
Performs data entry and matches documents to the appropriate accounts.
Interfaces with team members, management, and customers regarding claim adjudication issues.
Reviews client reports daily to ensure data integrity and submits reports to management.
Recommends workflow and procedure improvements to support efficient transaction processing.
Monitors daily claims transactions to ensure compliance with policies, procedures, and service level agreements.
Assists with day-to-day claims adjudication operations, including training and mentoring less experienced staff.