Claims Suspense Team Lead
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Claims Suspense Team Lead supporting Gainwell Technologies’ California Medi-Cal claims operations. Guiding examiners and monitoring suspended-claims workflow, quality, productivity, and turnaround times.
Responsibilities:
- Monitor suspended claims inventories and help prioritize aging claims to meet turnaround times and service level requirements
- Review, research, price, process, and resolve suspended claims according to Medi-Cal guidelines, policies, and procedures
- Provide day-to-day guidance, training, and operational support to Claims Examiners
- Assist with complex claims and questions
- Track team productivity, quality, claims inventory, and other operational metrics
- Communicate potential issues or trends to the Claims Suspense Supervisor
- Identify workflow, quality, and processing issues
- Support improvements to claims accuracy, productivity, and operational performance
- Serve as backup to the Claims Suspense Supervisor
- Help coordinate daily team activities and priorities
Requirements:
- Three or more years of experience in healthcare claims processing, claims adjudication, claims examination, claims suspense, Medicaid/Medi-Cal, or a related healthcare claims function
- Experience researching and resolving suspended, pended, denied, or exception healthcare claims
- Previous experience as a team lead, senior claims examiner, senior claims processor, or other position providing day-to-day guidance and support to team members is preferred
- Knowledge of healthcare claims processing, claims policies and procedures, reimbursement or pricing guidelines, and healthcare or insurance terminology
- Strong analytical and problem-solving skills
- Excellent attention to detail and commitment to quality and accuracy
- Strong communication and organizational skills
- Ability to prioritize work and support a team in a fast-paced, metrics-driven claims environment
- Broadband internet connection with a minimum speed of 24 Mbps download and 8 Mbps upload
Benefits:
- Work flexibility
- Learning and career development
- Flexible vacation policy
- 401(k) employer match
- Comprehensive health benefits
- Educational assistance
- Leadership and technical development academies
Similar Jobs
Publishing Team Lead
Publishing Team Lead leading managers and scaling CrazyLabs’ mobile games. Improving retention, monetization, and player experience through data-driven product strategy.
Team Lead, Provider Enrollment
Team Lead overseeing provider enrollment, credentialing, and re-credentialing for healthcare providers at Med-Metrix. Training offshore teams, monitoring quality, and ensuring HIPAA-compliant enrollment operations.
Field Service Team Lead
Field Service Team Lead leading engineers who install, repair, and support Biosense Webster cardiovascular systems. Field-based role serving hospitals across the eastern United States.
Field Service Team Lead
Field Service Team Lead leading engineers who install, repair, and support Biosense Webster cardiovascular equipment. Field-based role serving customers across the eastern United States.
Outbound Team Lead
Outbound Call Center Team Lead overseeing remote outreach agents for Compass Experience Labs’ digital health rewards campaign. Coaching performance, ensuring HIPAA compliance, and driving mobile app registrations.
Team Lead – BPO, Dutch
BPO Team Lead managing Dutch-speaking sales agents and KPI performance for WorkNomads’ global remote talent community. Coaching teams, resolving escalations, and improving contact-center operations.
Clinical Data Team Lead
Clinical Data Team Lead overseeing data management for clinical trials at Thermo Fisher Scientific. Leading project documentation, reporting, training, client liaison work, and junior staff mentoring.
Team Lead, Enterprise Service Desk
Enterprise Service Desk Team Lead providing advanced troubleshooting, analyst coaching, and Tier 3 escalations. Monitoring SLAs and resolving client incidents for an IT services organization.
Post Closing Investor Team Lead
Post Closing Investor Team Lead managing mortgage loan purchase conditions and investor escalations. Leading post-closing operations for CrossCountry Mortgage, a distributed retail mortgage lender.
Bodily Injury Claims Team Lead
Bodily Injury Claims Team Lead leading commercial transportation claims operations at Reserv. Overseeing adjusters, escalations, analytics, training, and client loss-mitigation reporting.
Team Lead – System Studies
Power system studies team lead guiding engineers, technical standards, and utility projects. NEI delivers electrical engineering services for utilities and renewable energy clients.
Claims Team Lead – Workers Compensation
Workers compensation claims team lead supervising examiner teams and claim adjudication for Sedgwick, a global claims management company. Providing California jurisdictional direction, quality oversight, and client support.
Migration Team Lead
Migration Team Lead driving DoD ICAM onboarding of 600 NIPRNet applications. Leading Okta, SailPoint, integration, UAT, and Zero Trust enablement operations.
Epic Radiant Team Lead
Epic Radiant Team Lead guiding analysts, stakeholders, and Radiant implementations. Prominence delivers healthcare IT staffing, advisory, and analytics solutions for healthcare organizations.
Team Lead, Marketplace Ordering – Trade
Team Lead scaling Havenly’s home-furnishings ordering and trade CX operations. Coaching teams, improving workflows, and driving post-purchase sales performance.
Digital Solutions Team Lead
Digital Solutions Team Lead supporting Solventum’s digital healthcare solutions and customer support operations. Coaching representatives, resolving escalations, monitoring metrics, and driving process improvements.
Enterprise Technical Team Lead
Enterprise Technical Team Lead securing client Azure and endpoint environments for F12’s managed services. Leading incident response, escalations, technician coaching, and continuous operational improvement.
Escrow Team Lead
Escrow Team Lead managing mortgage servicing escrow operations for LoanCare. Overseeing vendors, reporting, transfers, tax data, staff training, and special projects.
Claims Team Lead – Cargo
Cargo Claims Team Lead overseeing Commercial Transportation claims operations for Reserv, an AI-powered insurtech TPA. Coaching adjusters, handling escalations, and driving technology-enabled efficiency.
Team Ranger, Lead - L2
Microsoft Teams support lead troubleshooting M365 collaboration, voice, federation, identity, and networking issues. Supporting enterprise customers remotely from India.