Claims Appeals Team Lead - Onsite - West Sacramento, CA
Gainwell Technologies · West Sacramento, CA · 1 mo ago
On-siteSales$47k–$67k/yrFull-time
We need to output HTML fragment with sections: About the role? The posting includes summary and description. We need headings: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Only include sections with real specific content.
Let's parse content:
- About the role: The summary paragraph: "Gainwell Technologies is seeking an experienced Claims Appeals Team Lead to support appeals operations for California’s Medi-Cal program at our West Sacramento office. In this role, you will coordinate and support daily provider appeals operations to help ensure appeals are processed accurately, timely, and in accordance with established policies, regulatory requirements, and service-level expectations. Working under the direction of the Claims Appeals Supervisor, you will serve as a primary resource for Appeals Examiners, help coordinate daily workflow, provide training and guidance, monitor quality and performance, and assist with complex appeals and operational issues." That's about the role.
- Responsibilities: bullet list: "Coordinate daily provider appeals activities and help prioritize workloads to meet established turnaround times and service-level requirements. Provide day-to-day guidance, training, and operational support to Appeals Examiners and other team members. Review provider appeals for accuracy, completeness, and compliance with established policies, procedures, and departmental standards. Assist with quality assurance activities, identify processing issues or trends, and support corrective actions when needed. Track productivity, quality, turnaround times, inventory, and other performance metrics and provide status updates to leadership. Support process improvements designed to increase efficiency, improve accuracy, reduce operational issues, and enhance the provider experience."
- Requirements: "Three or more years of experience in healthcare claims, appeals and grievances, provider appeals, Medicaid/Medi-Cal, or a related healthcare function. Experience reviewing, researching, processing, or resolving healthcare claims or provider appeals."
- Qualifications: "Previous experience as a team lead, senior claims examiner, senior appeals examiner, or in a role providing day-to-day guidance and support to other employees is preferred."
- Skills: "Strong analytical and critical-thinking skills with excellent attention to detail and a commitment to quality and accuracy. Ability to train, coach, and support team members while helping coordinate workflow in a high-volume environment. Strong written and verbal communication skills with the ability to organize priorities and meet established deadlines."
- Benefits: "All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities."
- Pay: "The pay range for this position is $46,800 - $66,900 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors."
- Schedule: "This is a 100% onsite position at our West Sacramento, CA office. Remote or hybrid work is not available for this role. Standard work schedule is Monday through Friday, 6:00 AM to 2:30 PM."
We should not include duplicated lines, boilerplate, EEO, etc. Also not include "What You Should Expect In This Role" as separate heading; we can incorporate into schedule or responsibilities? The "What You Should Expect" includes schedule and environment; we already have schedule and maybe responsibilities. We'll keep schedule section as above.
We need to use for each section heading. Use
for each section heading. Use - for any list of duties/requirements/benefits. Use
for prose.
We need to preserve all substantive information; not invent or summarize away detail. So we need to keep the exact phrasing? Probably we can keep sentences as is, but we can break into list items.
We must not repeat job title as heading. Not include Job ID.
We must not include placeholder text like "commensurate with experience" etc. Not present.
We need to output only HTML fragment.
Let's craft:
About the role
Gainwell Technologies is seeking an experienced Claims Appeals Team Lead to support appeals operations for California’s Medi-Cal program at our West Sacramento office. In this role, you will coordinate and support daily provider appeals operations to help ensure appeals are processed accurately, timely, and in accordance with established policies, regulatory requirements, and service-level expectations. Working under the direction of the Claims Appeals Supervisor, you will serve as a primary resource for Appeals Examiners, help coordinate daily workflow, provide training and guidance, monitor quality and performance, and assist with complex appeals and operational issues.
Responsibilities
- Coordinate daily provider appeals activities and help prioritize workloads to meet established turnaround times and service-level requirements.
- Provide day-to-day guidance, training, and operational support to Appeals Examiners and other team members.
- Review provider appeals for accuracy, completeness, and compliance with established policies, procedures, and departmental standards.
- Assist with quality assurance activities, identify processing issues or trends, and support corrective actions when needed.
- Track productivity, quality, turnaround times, inventory, and other performance metrics and provide status updates to leadership.
- Support process improvements designed to increase efficiency, improve accuracy, reduce operational issues, and enhance the provider experience.
Requirements
- Three or more years of experience in healthcare claims, appeals and grievances, provider appeals, Medicaid/Medi-Cal, or a related healthcare function.
- Experience reviewing, researching, processing, or resolving healthcare claims or provider appeals.
Qualifications
Previous experience as a team lead, senior claims examiner, senior appeals examiner, or in a role providing day-to-day guidance and support to other employees is preferred.
Skills
- Strong analytical and critical-thinking skills with excellent attention to detail and a commitment to quality and accuracy.
- Ability to train, coach, and support team members while helping coordinate workflow in a high-volume environment.
- Strong written and verbal communication skills with the ability to organize priorities and meet established deadlines.
Benefits
- Generous, flexible vacation policy
- 401(k) employer match
- Comprehensive health benefits
- Educational assistance
- Variety of leadership and technical development academies to help build your skills and capabilities
Pay
The pay range for this position is $46,800 - $66,900 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.
Schedule
This is a 100% onsite position at our West Sacramento, CA office. Remote or hybrid work is not available for this role. Standard work schedule is Monday through Friday, 6:00 AM to 2:30 PM.
Check for any duplicated content: The "What You Should Expect In This Role" includes schedule and environment; we captured schedule. Also includes "fast-paced, metrics-driven healthcare appeals environment requiring strong prioritization, accuracy, and timely decision-making. This is a hands-on lead role that requires supporting Appeals Examiners while helping monitor daily workflow, quality, productivity, and turnaround times." That could be considered responsibilities or about the role. Might be missing. Should we include that as part of responsibilities? It's substantive. We could add a bullet under Responsibilities: "Support a fast-paced, metrics-driven healthcare appeals environment requiring strong prioritization, accuracy, and timely decision-making." But that's more description. However we already have responsibilities list; we could add a bullet: "Work in a fast-paced, metrics-driven healthcare appeals environment requiring strong prioritization, accuracy, and timely decision-making." Also "This is a hands-on lead role that requires supporting Appeals Examiners while helping monitor daily workflow, quality, productivity, and turnaround times." That's somewhat covered by responsibilities. To be safe, we could add a bullet under Responsibilities: "Work in a fast-paced, metrics-driven healthcare appeals environment requiring strong prioritization, accuracy, and timely decision-making." And maybe another: "Serve as a hands‑on lead supporting Appeals Examiners while monitoring daily workflow, quality, productivity, and turnaround times." But that may duplicate. However we must preserve ALL substantive information; we should not omit. So we need to incorporate those sentences.
Let's extract the exact sentences from "What You Should Expect In This Role":
"This is a 100% onsite position at our West Sacramento, CA office. Remote or hybrid work is not available for this role. Standard work schedule is Monday through Friday, 6:00 AM to 2:30 PM. You will work in a fast-paced, metrics-driven healthcare appeals environment requiring strong prioritization, accuracy, and timely decision-making. This is a hands-on lead role that requires supporting Appeals Examiners while helping monitor daily workflow, quality, productivity, and turnaround times."
We already have schedule and onsite info in Schedule section. The remaining two sentences: "You will work in a fast-paced, metrics-driven healthcare appeals environment requiring strong prioritization, accuracy, and timely decision-making." and "This is a hands-on lead role that requires supporting Appeals Examiners while helping monitor daily workflow, quality, productivity, and turnaround times."
We can add these as bullets under Responsibilities or maybe under About the role. Since they describe the role environment, we could add to About the role as a paragraph. But we already have About the role paragraph; we could append those sentences there. However we must not repeat info. Let's add them to About the role paragraph after the existing sentences.
Thus About the role paragraph becomes: original + "You will work in a fast-paced, metrics-driven healthcare appeals environment requiring strong prioritization, accuracy, and timely decision-making. This is a hands-on lead role that requires supporting Appeals Examiners while helping monitor daily workflow, quality, productivity, and turnaround times."
But note that the original already had "help coordinate daily workflow, provide training and guidance, monitor quality and performance, and assist with complex appeals and operational issues." The new sentence about monitoring daily workflow, quality, productivity, and turnaround times is somewhat overlapping but still distinct. We'll include.
Now ensure we didn't miss any other substantive info: The posting also includes "This posting is being used to build a pipeline of qualified candidates for current and future opportunities." That's boilerplate? It's about the posting; could be considered metadata but not essential. The instruction says remove duplicated lines, cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate, duplicated lines, and application instructions. The pipeline statement is not exactly boilerplate but could be considered meta. However it's substantive about the purpose of posting. Might be considered not essential to job description. The instruction: "Remove cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate, duplicated lines, and application instructions." The pipeline statement is not those categories. It's not application instruction. It's about the posting. Might be okay to keep? But it's not about role, responsibilities, etc. Could be considered filler. I'd lean to remove it as it's not directly about the job. The instruction says preserve ALL substantive information; does that include pipeline? It's about the recruiting process, not job content. I'd remove it to keep focused.
Also "Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development." That's motivational fluff; could be considered boilerplate? It's generic. Might be removed. The instruction says remove duplicated lines, cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate. This is not exactly those but could be considered fluff. However it's about company values; could be considered substantive? The earlier paragraph already mentions values. I'd remove to keep concise.
Also "
for prose. We need to preserve all substantive information; not invent or summarize away detail. So we need to keep the exact phrasing? Probably we can keep sentences as is, but we can break into list items. We must not repeat job title as heading. Not include Job ID. We must not include placeholder text like "commensurate with experience" etc. Not present. We need to output only HTML fragment. Let's craft:
About the role
Gainwell Technologies is seeking an experienced Claims Appeals Team Lead to support appeals operations for California’s Medi-Cal program at our West Sacramento office. In this role, you will coordinate and support daily provider appeals operations to help ensure appeals are processed accurately, timely, and in accordance with established policies, regulatory requirements, and service-level expectations. Working under the direction of the Claims Appeals Supervisor, you will serve as a primary resource for Appeals Examiners, help coordinate daily workflow, provide training and guidance, monitor quality and performance, and assist with complex appeals and operational issues.
Responsibilities
- Coordinate daily provider appeals activities and help prioritize workloads to meet established turnaround times and service-level requirements.
- Provide day-to-day guidance, training, and operational support to Appeals Examiners and other team members.
- Review provider appeals for accuracy, completeness, and compliance with established policies, procedures, and departmental standards.
- Assist with quality assurance activities, identify processing issues or trends, and support corrective actions when needed.
- Track productivity, quality, turnaround times, inventory, and other performance metrics and provide status updates to leadership.
- Support process improvements designed to increase efficiency, improve accuracy, reduce operational issues, and enhance the provider experience.
Requirements
- Three or more years of experience in healthcare claims, appeals and grievances, provider appeals, Medicaid/Medi-Cal, or a related healthcare function.
- Experience reviewing, researching, processing, or resolving healthcare claims or provider appeals.
Qualifications
Previous experience as a team lead, senior claims examiner, senior appeals examiner, or in a role providing day-to-day guidance and support to other employees is preferred.
Skills
- Strong analytical and critical-thinking skills with excellent attention to detail and a commitment to quality and accuracy.
- Ability to train, coach, and support team members while helping coordinate workflow in a high-volume environment.
- Strong written and verbal communication skills with the ability to organize priorities and meet established deadlines.
Benefits
- Generous, flexible vacation policy
- 401(k) employer match
- Comprehensive health benefits
- Educational assistance
- Variety of leadership and technical development academies to help build your skills and capabilities
Pay
The pay range for this position is $46,800 - $66,900 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.
Schedule
This is a 100% onsite position at our West Sacramento, CA office. Remote or hybrid work is not available for this role. Standard work schedule is Monday through Friday, 6:00 AM to 2:30 PM.
Check for any duplicated content: The "What You Should Expect In This Role" includes schedule and environment; we captured schedule. Also includes "fast-paced, metrics-driven healthcare appeals environment requiring strong prioritization, accuracy, and timely decision-making. This is a hands-on lead role that requires supporting Appeals Examiners while helping monitor daily workflow, quality, productivity, and turnaround times." That could be considered responsibilities or about the role. Might be missing. Should we include that as part of responsibilities? It's substantive. We could add a bullet under Responsibilities: "Support a fast-paced, metrics-driven healthcare appeals environment requiring strong prioritization, accuracy, and timely decision-making." But that's more description. However we already have responsibilities list; we could add a bullet: "Work in a fast-paced, metrics-driven healthcare appeals environment requiring strong prioritization, accuracy, and timely decision-making." Also "This is a hands-on lead role that requires supporting Appeals Examiners while helping monitor daily workflow, quality, productivity, and turnaround times." That's somewhat covered by responsibilities. To be safe, we could add a bullet under Responsibilities: "Work in a fast-paced, metrics-driven healthcare appeals environment requiring strong prioritization, accuracy, and timely decision-making." And maybe another: "Serve as a hands‑on lead supporting Appeals Examiners while monitoring daily workflow, quality, productivity, and turnaround times." But that may duplicate. However we must preserve ALL substantive information; we should not omit. So we need to incorporate those sentences. Let's extract the exact sentences from "What You Should Expect In This Role": "This is a 100% onsite position at our West Sacramento, CA office. Remote or hybrid work is not available for this role. Standard work schedule is Monday through Friday, 6:00 AM to 2:30 PM. You will work in a fast-paced, metrics-driven healthcare appeals environment requiring strong prioritization, accuracy, and timely decision-making. This is a hands-on lead role that requires supporting Appeals Examiners while helping monitor daily workflow, quality, productivity, and turnaround times." We already have schedule and onsite info in Schedule section. The remaining two sentences: "You will work in a fast-paced, metrics-driven healthcare appeals environment requiring strong prioritization, accuracy, and timely decision-making." and "This is a hands-on lead role that requires supporting Appeals Examiners while helping monitor daily workflow, quality, productivity, and turnaround times." We can add these as bullets under Responsibilities or maybe under About the role. Since they describe the role environment, we could add to About the role as a paragraph. But we already have About the role paragraph; we could append those sentences there. However we must not repeat info. Let's add them to About the role paragraph after the existing sentences. Thus About the role paragraph becomes: original + "You will work in a fast-paced, metrics-driven healthcare appeals environment requiring strong prioritization, accuracy, and timely decision-making. This is a hands-on lead role that requires supporting Appeals Examiners while helping monitor daily workflow, quality, productivity, and turnaround times." But note that the original already had "help coordinate daily workflow, provide training and guidance, monitor quality and performance, and assist with complex appeals and operational issues." The new sentence about monitoring daily workflow, quality, productivity, and turnaround times is somewhat overlapping but still distinct. We'll include. Now ensure we didn't miss any other substantive info: The posting also includes "This posting is being used to build a pipeline of qualified candidates for current and future opportunities." That's boilerplate? It's about the posting; could be considered metadata but not essential. The instruction says remove duplicated lines, cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate, duplicated lines, and application instructions. The pipeline statement is not exactly boilerplate but could be considered meta. However it's substantive about the purpose of posting. Might be considered not essential to job description. The instruction: "Remove cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate, duplicated lines, and application instructions." The pipeline statement is not those categories. It's not application instruction. It's about the posting. Might be okay to keep? But it's not about role, responsibilities, etc. Could be considered filler. I'd lean to remove it as it's not directly about the job. The instruction says preserve ALL substantive information; does that include pipeline? It's about the recruiting process, not job content. I'd remove it to keep focused. Also "Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development." That's motivational fluff; could be considered boilerplate? It's generic. Might be removed. The instruction says remove duplicated lines, cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate. This is not exactly those but could be considered fluff. However it's about company values; could be considered substantive? The earlier paragraph already mentions values. I'd remove to keep concise. Also "