Claims Examiner - Madison, WI (On-site)

Gainwell Technologies LLC•Madison, WI

2d•Onsite

About The Position

As a Claims Examiner at Gainwell, you will be part of a team dedicated to supporting the accurate and timely processing of claims. In this role, you will analyze claims data, review and process claims, and work directly with healthcare providers to ensure compliance with claims guidelines and service standards. This position requires onsite work 5 days per week at our Madison, WI office located at 313 Blettner Blvd, Madison, WI 53784.

Requirements

Previous experience in claims processing or a related field.
Strong organizational skills with attention to detail and accuracy.
Excellent written and verbal communication skills to interact effectively with team members and providers.
Ability to manage time and prioritize tasks effectively in a high-paced environment.
Proficiency in Microsoft Office Suite and claims processing software.

Responsibilities

Review and process healthcare claims in alignment with policies and regulations, ensuring accuracy and compliance.
Communicate with providers and healthcare professionals to clarify claims issues and obtain additional information as needed.
Document claim status, decisions, and follow-up actions, maintaining organized records for audit and reporting.
Participate in quality control processes, ensuring claims are processed in a timely and accurate manner.
Identify claim discrepancies and work with relevant teams to resolve issues efficiently.
Maintain up-to-date knowledge of claims policies, industry regulations, and service requirements.
Collaborate with internal teams to improve claims processing workflows and resolve claim discrepancies.
Contribute to quality improvement initiatives in claims processing.
Maintain a professional approach while interacting with healthcare providers and team members.
Regularly report claim processing metrics and issues to leadership.
Stay informed of industry updates and best practices for claims examination.