Finance Manager (Remote in US)

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

We are seeking a dynamic Finance Manager to serve as a financial leader in building and implementing a high-performing financial operations team based in Ohio. This pivotal role will support our engagement with a key client and requires regular interaction with external vendors. The manager will be responsible for overseeing weekly pay cycles, claims management, and the escalated ticket resolution process. The ideal candidate will be highly skilled in financial operations, compliance, and team leadership, with a proven ability to operate effectively in a demanding yet rewarding environment. If you are a strategic finance leader who thrives in a mission-driven, client-focused environment, we encourage you to apply!

Your role in our mission

• Lead and manage all contract requirements, ensuring adherence to service level agreements (SLAs) and operational timelines.
• Oversee and perform day-to-day financial activities associated with pharmacy claims and fee-for-service claims adjudication.
• Oversee provider recoupment processes and weekly payment cycle operations, ensuring timely and accurate disbursements.
• Manages and coordinates non-risk payment process involving managed care.
• Performs quality assurance activities involving fee-for-service RX, SPBM, Med-dent, and capitation payment cycles.
• Primary point-of-contact for pharmacy and fee-for- service claim payment financial topics for the client and stakeholders.
• Contributes to financial related client and stakeholder communications, outreach, and strategies.
• Updates pharmacy and fee-for-service claim payment procedures and associated materials, including policies and procedures, desk-level procedures, and manuals.
• Manage escalated tickets, providing swift and appropriate resolution while maintaining high client satisfaction.
• Direct the end-to-end medical claims and single pharmacy benefit claims management processes.
• Collaborate closely with the state client and external vendors to maintain compliance and operational excellence.
• Establish and foster a high-performance team environment focused on accountability, results, and continuous improvement.
• Provide clear leadership in managing people, driving team development, and nurturing a culture of excellence.
• Demonstrate advanced knowledge of business operations, finance, and technical processes to support administrative functions and cross-functional collaboration.
• Proactively identify and pursue business opportunities while resolving complex financial and operational issues, especially within claims management.
• Ensure compliance with all applicable federal, state, and local regulations related to finance and claims processing.

What we're looking for

• Bachelor’s degree in Finance, Accounting, Business Administration, or a related field (master’s degree preferred).

• 5+ years of experience in a leadership or managerial role in healthcare finance operations (required). Proven experience managing remote teams and creating productive, collaborative remote work environments (preferred).

• Strong knowledge of claims processing, particularly medical and pharmacy claims. Medicaid and PBM claims experience (preferred).

• Experience managing vendor relationships and working directly with government clients is highly (preferred).

• Exceptional organizational, analytical, and communication skills.

• Technical/Systems Knowledge including, but not limited to
  • Experience with using Vue360 and/or Vue360Rx.
  • Ability to create and analyze data using SQL.
  • Functional knowledge of the following:
  • Service Now (required)
  • Cypress (preferred)
  • Citrix (preferred)
  • Remote Desktop for servers (preferred)

What you should expect in this role

• This is a 100% remote position, with the required monthly travel to Ohio for client presentations.
• This is a full-time permanent regular salaried (W-2) employee position.
  • 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.
• 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.
• This position is intended for pipelining. We will accept applications on an ongoing basis.

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The pay range for this position is $86,400 - $123,900 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.