Medical Claims Research Analyst - Remote California

Gainwell Technologies LLC•Any city, OH

2d•$70,000 - $75,000•Remote

About The Position

The Medical Claims Research Analyst supports providers, clients, and internal stakeholders through comprehensive medical claims research, issue resolution, correspondence, and operational support. This role investigates routine to complex medical claims and provider inquiries, develops accurate and timely responses, and collaborates across multiple functional areas to resolve issues. The ideal candidate demonstrates strong analytical, research, communication, and problem-solving skills with the ability to work independently while ensuring accurate and compliant outcomes.

Requirements

Three or more years of experience in healthcare operations, medical claims processing, claims research, provider support, customer service, business process outsourcing, or a related field; Medi-Cal or Medicaid experience preferred.
Experience researching and resolving medical claims, provider inquiries, and related healthcare operational issues.
Strong analytical, research, problem-solving, organizational, and decision-making skills with the ability to manage multiple priorities.
Excellent written, verbal, and interpersonal communication skills with experience collaborating with providers, clients, and cross-functional business partners.
Working knowledge of provider operations, medical claims processing, customer support practices, and business systems used to research, track, and resolve inquiries.
Experience working with business processes, identifying improvement opportunities, and developing practical solutions that improve operational effectiveness.

Nice To Haves

Medi-Cal or Medicaid experience preferred.

Responsibilities

Research, analyze, and resolve routine to complex medical claims, provider inquiries, program questions, and operational issues using established policies, procedures, and available resources.
Manage claims research and correspondence by reviewing inquiries, monitoring case progress, prioritizing assignments, and ensuring accurate and timely resolution.
Collaborate with providers, clients, leadership, and cross-functional teams to resolve issues, facilitate escalations, and support program initiatives.
Contribute to shared knowledge resources by documenting complex issue resolution, identifying trends, and supporting consistent application of policies and procedures.
Identify process improvement opportunities and recommend solutions that improve efficiency, service delivery, and customer outcomes.
Support knowledge-sharing and training activities while interpreting and applying applicable federal, state, client, and organizational requirements.