SummaryThe Manager, Service Delivery - CEF Center of Excellence serves as a key leader responsible for developing and executing strategies that drive operational excellence across Medicaid claims processing, including mailroom, data entry and claims issue resolution workflows. This role ensures accurate, compliant, and timely claims processing aligned with CMS and state Medicaid requirements while optimizing efficiency, reducing rework, and improving provider and member experience.
The Manager partners cross-functionally with Operations, Compliance, IT, and Client stakeholders to embed standardized, data-driven processes and ensure alignment with regulatory requirements, payer-specific rules, and organizational policies. This role is accountable for identifying operational risks, improving claims automation, reducing manual claims efforts, and delivering measurable performance improvements through strategic planning and execution.
Your role in our mission- Lead initiatives to optimize end-to-end claims lifecycle, including mailroom intake, data entry, reduce manual touches in claims adjudication and adjustment processing.
- Design and implement process standardization and best practices across institutional and professional claim streams
- Develop and execute claims operations strategies to improve accuracy, turnaround time, and cost efficiency across Medicaid workflows
- Analyze claims data, denial trends, and process steps to identify root causes, systemic issues, and opportunities for improvement
- Defining business and technical requirements to support mailroom and claims operations, systems, workflows, and compliance
- Developing reporting frameworks, dashboards, and KPI structures to drive operational visibility and performance
- Partnering with product and engineering teams to ensure systems and data capture meet business and reporting needs
- Supporting Design, Development and Implementation (DDI) efforts to ensure alignment with enterprise standards and data requirements
- Supporting governance, executive reporting, roadmap planning, and strategic initiatives.
- Drive continuous improvement initiatives using data analytics, process improvement methodologies, and automation opportunities
- Establish and maintain operational playbooks and governance structures for claims processing and issue management
What we're looking for- Five (5) or more years of experience in Medicaid operations, claims management, mailroom intake operations, or business analysis
- Strong analytical and problem-solving skills with the ability to interpret claims data, identify trends, and drive actionable insights, and experience with data and reporting tools (e.g., Excel, Power BI) and applying insights to improve claims operations performance
- Proven ability to lead cross-functional initiatives across operations, compliance, and IT in a healthcare payer environment
- Strong knowledge of Medicaid claims processing, CMS guidelines, and coordination of benefits workflows
- Excellent communication and stakeholder management skills, with experience influencing senior leadership and external partners
What you should expect in this role- This is a full-time permanent regular salaried (W-2) employee position.
- Possible quarterly travel for onsite meeting with team. This is company paid.
- Monday through Friday work schedule (40 hours per week).
- Health (medical, dental, vision) benefits start on day 1 of employment.
- Company match 401K and other benefits available within months of starting.
- New employees are eligible to take advantage of flexible vacation policy after ninety (90) calendar days of employment. Any exception requires manager approval prior to employee's Gainwell start date.
- Company provided computer for work use.
- For all hybrid and remote positions employees' Broadband Internet connections, should have a minimum speed of 24MBS download and 8 MBS upload. Greater speeds will of course provide better performance.
- Video cameras must be used during all interviews, as well as during the initial week of orientation if hired.
- The use of AI during interviews is prohibited.
- This position will remain posted to take applications until July 27, 2026.
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The pay range for this position is $86,700.00 - $123,900.00 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 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.
