Healthcare Claims Operations Team Lead - Washington, DC (On-site)

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.

Summary

As a Healthcare Claims Operations Team Lead at Gainwell, you will lead a team responsible for medical claims processing, resolution, and financial reconciliation supporting Medicaid and Medicare programs.

You will oversee end-to-end healthcare claims operations, including claims adjudication, complex issue resolution, payment accuracy, and compliance with CMS guidelines. This role serves as a subject matter expert in health insurance claims workflows and financial processes, while driving operational efficiency, quality, and continuous improvement.

Your role in our mission

• Lead, mentor, and develop a team supporting medical claims processing, adjudication, and resolution
• Oversee the full lifecycle of healthcare claims, ensuring accuracy, timeliness, and service excellence
• Resolve complex and escalated Medicaid and Medicare claims issues, including discrepancies and exceptions
• Manage claims-related financial processes, including payments, reimbursements, adjustments, and reconciliations
• Partner with cross-functional teams across finance, compliance, IT, and operations to optimize workflows and performance

What we're looking for

• 5-7+ years of experience in medical claims, healthcare claims, or health insurance operations
• Strong experience working with Medicaid and/or Medicare claims
• Experience with end-to-end claims lifecycle, including adjudication, processing, and resolution
• Knowledge of claims-related financial processes, including reconciliation, payments, and adjustments
• Proven experience leading or supervising teams in a healthcare claims or insurance environment

What you should expect in this role

• Onsite position located at Gainwell Technologies, 1111 19th St NW, Suite 1000, Washington, DC
• Opportunity to lead high-impact healthcare claims operations supporting government-sponsored programs
• A collaborative environment focused on operational excellence, compliance, and continuous improvement
• Career growth within a company that values innovation, flexibility, and professional development
• Exposure to cross-functional leadership and strategic initiatives across claims, finance, and compliance teams

*This posting is intended for pipelining. We will accept applications on an ongoing basis.

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The pay range for this position is $50,000 - $55,000 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 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.

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.

Nearest Major Market: Washington DC