Medical Claims Research Analyst Lead - Remote California

Gainwell Technologies LLC•West Sacramento, CA

9d•$70,000 - $80,000•Remote

About The Position

The Medical Claims Research Analyst Lead serves as a functional lead for the Research Analyst team, providing guidance, support, and expertise in resolving complex claims research, provider inquiries, correspondence, and operational issues. The role collaborates with internal departments, leadership, providers, clients, and external stakeholders to ensure timely, accurate, and compliant research outcomes while supporting operational excellence and continuous process improvement. The successful candidate demonstrates leadership, analytical, communication, and problem-solving skills and acts as a subject matter expert for complex inquiries and escalations. This is a remote position for someone residing in California. Occasional onsite attendance may be required for meetings, training, operational initiatives, or other business needs, and reliable high-speed internet is required. This is a pipeline requisition intended to build a pool of qualified candidates for current and future opportunities as positions become available.

Requirements

Three or more years of experience in healthcare operations, medical claims processing, provider support, customer service, business process outsourcing, research, or a related field.
Functional lead experience, with the ability to provide direction, coaching, mentoring, and support within a team environment.
Strong analytical, research, problem-solving, organizational, and decision-making skills.
Excellent written, verbal, interpersonal, presentation, and facilitation skills, with the ability to collaborate effectively with providers, clients, leadership, and cross-functional teams.
Experience assessing business processes, identifying improvement opportunities, and developing practical solutions that improve operational effectiveness and service quality.
Working knowledge of healthcare regulations, provider operations, medical claims processing, customer support practices, and business systems used to research, track, and resolve inquiries.
Must reside in California.
Reliable high-speed internet connectivity is required.

Nice To Haves

Medi-Cal or Medicaid experience.

Responsibilities

Provide functional leadership and day-to-day guidance to the Research Analyst team, supporting complex inquiries, escalations, claims research, and correspondence while promoting consistency, quality, and timely resolution.
Support investigation and resolution of routine to highly complex medical claims, provider, client, and operational inquiries using subject matter expertise, independent judgment, and established policies and procedures.
Collaborate with providers, clients, leadership, and cross-functional business partners to resolve escalated issues, support program initiatives, and ensure compliance with applicable requirements.
Contribute to knowledge management resources, develop best practices, and support staff training and mentoring while documenting complex issue resolution and operational guidance.
Identify process improvement opportunities, analyze operational trends, and recommend solutions that improve efficiency, service delivery, customer satisfaction, and business outcomes.