Supervisor, Claims Services - Remote US

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

Supervises claims audit operations within Pharmacy Benefit Management (PBM) services. Ensures accurate adjudication of pharmacy claims while maintaining compliance with Medicaid requirements and operational performance standards. The Claims Audit Supervisor will have oversight of all FWA Audit Services including Concurrent Claims Review, Desk Audit and Field Audit.

Your role in our mission

• Lead and develop a team responsible for drug claims auditing and adjudication activities
• Oversee claim audit workflows to ensure accuracy, timeliness, and compliance with PBM and Medicaid guidelines
• Monitor performance metrics (productivity, quality, turnaround times) and implement process improvements to identify discrepancies.
• Manage escalations and resolve complex claims issues involving members, providers, and pharmacies
• Partner with internal teams to support system updates, audits, and ongoing claims operations
• Work with state to present audit findings, develop new capabilities and manage appeal processes
  
  

What We're Looking For

• 5+ years of experience in pharmacy operations, drug claims processing, audit, or related healthcare environments
• 2+ years of leadership experience managing teams and driving performance
• Strong expertise in pharmacy claims adjudication, Medicaid programs, audit processes, and identifying claims anomalies
• Nationally Certified Pharmacy Technician (CPhT) required; CFE or AHFI certification preferred
• Experience with client communications, reporting (KPIs), and driving operational improvements
  
  

What You Should Expect In This Role

• Leadership within a high-volume audit processing environment
• Collaboration with pharmacy, clinical, clients and IT teams
• Focus on accuracy, compliance, and operational efficiency
  
  

The pay range for this position is $47,300.00 - $67,600.00 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.

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.