Claims Resolution Specialist Remote Pennsylvania

Gainwell Technologies LLC•Any city, OH

20h•$35,000 - $50,000•Remote

About The Position

Gainwell Technologies is responsible for all Claims Operation and Management functions of Medical Assistance Services. The primary role of a Claims Resolution Specialist is to provide exceptional customer support for incoming and outgoing Provider Claims processing. This role involves reviewing, researching, and processing claims in accordance with established claims processing guidelines. Specialists will also refer claims to the appropriate department and prepare Return to Provider (RTP) forms when required information is missing or invalid. The position requires strong time management, organizational skills, and the ability to work independently in a fast-paced environment. Collaboration across multiple teams is essential, as is managing competing priorities and meeting established deadlines. Maintaining accurate workload tracking and communicating status updates, challenges, and potential roadblocks to leadership in a timely manner are key responsibilities.

Requirements

Strong attention to detail, accuracy, and commitment to maintaining a consistent work schedule.
Ability to multitask effectively while demonstrating strong data entry and organizational skills, including knowledge of the Julian calendar.
Proficiency in Microsoft Office Suite with excellent verbal and written communication skills.
Experience using multiple systems to research, gather, and analyze information necessary for claims processing.
Experience in healthcare insurance and/or medical claims, with the ability to read, interpret, and apply basic to moderately complex operating procedures and documentation.
Strong analytical and problem-solving skills with the ability to make sound decisions and resolve issues effectively.
Excellent interpersonal and communication skills, with the ability to collaborate with team members and interact professionally with clients.
Ability to handle sensitive and confidential information with discretion and professionalism.
Must reside in Pennsylvania to be eligible for this remote position.

Responsibilities

Review, research, and process claims in accordance with established claims processing guidelines.
Refer claims to the appropriate department and prepare Return to Provider (RTP) forms when required information is missing or invalid.
Demonstrate strong time management, organizational skills, and the ability to work independently in a fast-paced environment.
Collaborate effectively across multiple teams while managing competing priorities and meeting established deadlines.
Maintain accurate workload tracking and communicate status updates, challenges, and potential roadblocks to leadership in a timely manner.