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Claims Suspense Team Lead
Gainwell Technologies. Monitor suspended claims inventories and help prioritize aging claims to meet turnaround times and service level requirements .
Posted 9/19/2026full-timeRemote • California • United StatesSenior💰 $37,500 - $53,500 per yearWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in healthcare claims processing, including the ability to research and resolve suspended claims while ensuring compliance with Medi-Cal guidelines. Strong analytical, communication, and organizational skills are essential for supporting team productivity and operational performance.
Highest-signal resume keywords
Healthcare Claims ProcessingClaims AdjudicationClaims ExaminationAnalytical SkillsTeam Leadership
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims ProcessingClaims ResolutionClaims PricingClaims PoliciesMedi-Cal GuidelinesHealthcare TerminologyOperational MetricsQuality AssuranceProblem-SolvingAttention to Detail
Soft Skills
Communication SkillsOrganizational SkillsTeam SupportPrioritizationCommitment to Quality
Industry Keywords
MedicaidClaims InventoryClaims SuspenseHealthcare Claims FunctionMetrics-Driven Environment
About the role
Key responsibilities & impact- 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
What you’ll need- 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
Comp & perks- Work flexibility
- Learning and career development
- Flexible vacation policy
- 401(k) employer match
- Comprehensive health benefits
- Educational assistance
- Leadership and technical development academies