Adjudication Lead - Roseville, CA (Hybrid)

About the role

Join us and put your expertise to work in ways you never imagined possible. At Gainwell, you’ll have the opportunity to grow your career in a company that values work-life balance, continuous learning, and career development. Your role will involve solving business challenges and enhancing the way we work.

Responsibilities

• Answer questions from the claims adjudication team and respond to complex customer inquiries or route them to the appropriate personnel.
• Research and respond to customer inquiries in a timely manner.
• Process requests and update account history with proper documentation.
• Process and distribute incoming and outgoing work in accordance with service level agreements.
• Perform data entry and match documents to the appropriate accounts.
• Interface with team members, management, and customers regarding claim adjudication issues.
• Review client reports daily to ensure data integrity and submit reports to management.
• Recommend workflow and procedure improvements to support efficient transaction processing.
• Monitor daily claims transactions to ensure compliance with policies, procedures, and service level agreements.
• Assist with day-to-day claims adjudication operations, including training and mentoring less experienced staff.

Requirements

• High school diploma or G.E.D.
• Three or more years of experience in Claims, TARs, CIFs, NOAs, or RTDs.
• Experience working with organizational functions and personnel.
• Experience with computer software, CRM technology, and Mainframe.
• Experience working with and skilled in the use of help desk software.

Schedule

• Remote hybrid work arrangement with 2 days per week in the Roseville, CA office, depending on business and client needs.
• Monday through Friday schedule.
• Up to 10% travel required.

Pay

The pay range for this position is $70,304.00 - $76,000.00 per year. The base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.

Benefits

• Generous, flexible vacation policy.
• 401(k) employer match.
• Comprehensive health benefits.
• Educational assistance.
• Leadership and technical development academies to help build your skills and capabilities.