Adjudication Lead - Roseville, CA (Hybrid)

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.

Summary

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development.

Your role in our mission

• Answers questions from the claims adjudication team and responds to complex customer inquiries or routes them to the appropriate personnel.
• Researches and responds to customer inquiries in a timely manner.
• Processes requests and updates account history with proper documentation.
• Processes and distributes incoming and outgoing work in accordance with service level agreements.
• Performs data entry and matches documents to the appropriate accounts.Interfaces with team members, management, and customers regarding claim adjudication issues.
• Reviews client reports daily to ensure data integrity and submits reports to management.
• Recommends workflow and procedure improvements to support efficient transaction processing.
• Monitors daily claims transactions to ensure compliance with policies, procedures, and service level agreements.
• Assists with day-to-day claims adjudication operations, including training and mentoring less experienced staff.

What we're looking for

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

What you should expect in this role

• 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.

This position will remain open for applications through September 10, 2026.

The pay range for this position is $70,304.00 - $76,000.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. 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. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a , and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our and visit our for all available job role openings.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.