Claims and Finance Lead - Washington, DC - Onsite
Gainwell Technologies
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Job Description
Summary
The Senior Claims Resolution & Finance Team Lead is a key leadership role responsible for overseeing end‑to‑end claims management operations, financial accuracy, and process optimization within the claims resolution function. This role manages a team of analysts and specialists focused on timely claim adjudication, dispute resolution, financial reconciliation, and compliance with internal policies and external regulations. The Senior Team Lead acts as an operational expert, strategic partner, and coach—driving performance, ensuring quality, and advancing continuous improvement initiatives.
Your role in our mission
- Leadership & Team Management: Lead, mentor, and coach claims resolution and finance teams; oversee workload, staffing, and training to achieve performance, quality, and accuracy goals.
- Claims Resolution & Operational Oversight: Manage the full claims lifecycle, resolving complex cases, establishing standards for turnaround time, accuracy, and service excellence.
- Financial Reconciliation & Reporting: Oversee financial processes including payments, reimbursements, adjustments, and reconciliations; review reports and address discrepancies or process gaps.
- Process Improvement & Strategy: Analyze workflows and metrics to identify inefficiencies; partner with IT, compliance, and finance teams to optimize processes and implement best practices.
- Cross-Functional Collaboration & Compliance: Collaborate with internal partners across Finance, Operations, Legal, and Customer Support; ensure regulatory compliance, monitor internal controls, and serve as subject matter expert for claims and financial processes.
- Education & Experience: Bachelor’s degree (or equivalent experience) in Business, Finance, Accounting, Healthcare Administration, or a related field; 5–7+ years in claims resolution, financial operations, or related roles, including 2–3+ years of leadership experience.
- Claims & Financial Expertise: Proven knowledge of claims workflows, financial reconciliation, and analytical problem-solving; high proficiency with claims management systems and MS Office.
- Leadership & Team Management: Strong skills in coaching, stakeholder management, communication, and negotiation to lead and develop high-performing teams.
- Industry & Regulatory Knowledge: Experience in BPO, healthcare, insurance, or shared services operations; familiarity with relevant regulatory environments (e.g., CMS, insurance compliance).
- Core Competencies: Operational excellence, process optimization, quality assurance, analytical thinking, conflict resolution, and strategic decision-making.
- Work from Gainwell’s office in downtown DC, Monday to Friday, 8:00AM to 5:00PM, Monday to Friday. This is an in-person and in-office role with no limited home or remote work opportunities.
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 company website and visit our Careers site 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.
About The Company
Gainwell Technologies
For 50 years, our nation’s federal Medicaid program has worked to improve the health, safety and well-being of America’s most vulnerable populations: low-income families, women and children, seniors, and those with disabilities. With positive health and cost outcomes that pierce inequities and impact economies, the success of these programs is inextricably tied to the prosperity of communities, individual states and the nation as a whole. We think that demands respect and, more importantly, is deserving of a lifetime commitment from innovators who can help those who operate within and around health and human services evolve — in any market at any stage. At Gainwell Technologies, that’s our sole focus. Built across more than five decades, Gainwell has intentionally seized opportunities to advance its digitally enabled services to meet agencies, health plans and MCOs where they are on their modernization journeys and propel them into the future of public health. Our commitment to innovation, deep experience and ability to leverage insights from customers across 50 states has allowed us to expand on next-generation, cloud-enabled technologies. Today, Gainwell offers one of the most comprehensive suites of scalable services and solutions on the market — all proven to deliver cost savings, better patient outcomes and an improved provider experience. Equally important to our expanding technologies and results: We bring ideas that bring policies to life.
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