Claims Examiner - Remote US
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 to ensure compliance with claims guidelines and service standards. Your role in our mission involves reviewing and processing healthcare claims in alignment with policies and regulations, ensuring accuracy and compliance. You will document claim status, decisions, and follow-up actions, maintaining organized records for audit and reporting. Additionally, you will 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, and maintain up-to-date knowledge of claims policies, industry regulations, and service requirements.
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.
- Ability to manage time and prioritize tasks effectively in a high-paced environment.
- Proficiency in Microsoft Office Suite and claims processing software.
- Reliable home internet required: minimum 24 Mbps download / 8 Mbps upload (higher speeds strongly recommended).
Responsibilities
- Review and process healthcare claims in alignment with policies and regulations, ensuring accuracy and compliance.
- 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.
Benefits
- Health, dental, and vision benefits begin on day one
- 401(k) matching
- Additional benefits available
- Generous, flexible vacation policy
- Comprehensive health benefits
- Educational assistance
- Variety of leadership and technical development academies
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
