Healthcare Claims Operations Team Lead - Washington, DC (On-site)

Gainwell Technologies LLC•Washington, DC

120d•$50,000 - $55,000•Onsite

About The Position

As a Healthcare Claims Operations Team Lead at Gainwell, you will lead a team responsible for medical claims processing, resolution, and financial reconciliation supporting Medicaid and Medicare programs. You will oversee end-to-end healthcare claims operations, including claims adjudication, complex issue resolution, payment accuracy, and compliance with CMS guidelines. This role serves as a subject matter expert in health insurance claims workflows and financial processes, while driving operational efficiency, quality, and continuous improvement.

Requirements

5–7+ years of experience in medical claims, healthcare claims, or health insurance operations
Strong experience working with Medicaid and/or Medicare claims
Experience with end-to-end claims lifecycle, including adjudication, processing, and resolution
Knowledge of claims-related financial processes, including reconciliation, payments, and adjustments
Proven experience leading or supervising teams in a healthcare claims or insurance environment

Responsibilities

Lead, mentor, and develop a team supporting medical claims processing, adjudication, and resolution
Oversee the full lifecycle of healthcare claims, ensuring accuracy, timeliness, and service excellence
Resolve complex and escalated Medicaid and Medicare claims issues, including discrepancies and exceptions
Manage claims-related financial processes, including payments, reimbursements, adjustments, and reconciliations
Partner with cross-functional teams across finance, compliance, IT, and operations to optimize workflows and performance