Medi-Cal Conlan Team Lead - Hybrid - West Sacramento, CA
About The Position
Gainwell Technologies is seeking an experienced Medi-Cal Conlan Team Lead to support California’s Medi-Cal program and Conlan operations. In this role, you will provide day-to-day guidance and operational support to team members responsible for processing Conlan member reimbursement claims. You will serve as a subject matter expert (SME), help guide team workflows, support complex cases and escalations, and help ensure work is completed accurately and in accordance with established requirements and service level agreements (SLAs). This is a hands-on lead role that combines Conlan case processing with team support, workflow coordination, research, reporting, and problem resolution.
Requirements
- High school diploma or equivalent.
- Two or more years of experience in customer service, healthcare, healthcare claims, member services, provider services, medical reimbursement, or related healthcare operations.
- Ability to follow detailed policies, procedures, Court Order requirements, and established operational protocols.
- Strong analytical, critical-thinking, problem-solving, organizational, and communication skills with excellent attention to detail.
Nice To Haves
- Experience providing guidance, training, workflow support, or subject matter expertise to other employees preferred.
- Experience researching, reviewing, processing, or resolving healthcare claims, reimbursement requests, member cases, or similar healthcare transactions preferred.
Responsibilities
- Research and process Conlan member reimbursement claims in accordance with established Court Order requirements, policies and procedures, and SLA standards.
- Provide day-to-day guidance and operational support to team members, including answering process-related questions and assisting with complex cases.
- Help guide and review team workflows to support established productivity, quality, accuracy, and service-level expectations.
- Review member reimbursement requests, including incomplete requests, approvals, and denials, for completeness, accuracy, and compliance with applicable requirements.
- Collaborate with team members, leadership, clients, and customers to research and resolve claim-related issues, member cases, and escalations.
- Assist the Supervisor and senior leadership with claim research, operational reporting, workflow priorities, special projects, and other assignments.
Benefits
- flexible vacation policy
- 401(k) employer match
- comprehensive health benefits
- educational assistance
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
