Medical Claims Resolution Analyst - Remote US
About The Position
Gainwell Technologies is responsible for Claims Operations and Management functions supporting Federal and State Medical Assistance Services programs. As a Claims Resolution Analyst, you will play a key role in researching, resolving, and processing provider claims while ensuring accuracy, compliance, and exceptional customer support. Your role in our mission involves reviewing, researching, and resolving medical and dental claims in accordance with established processing guidelines and procedures. You will analyze claims issues and collaborate with internal departments to ensure timely and accurate resolution. You will manage multiple priorities while maintaining productivity, accuracy, and service-level expectations. You will also communicate claim status, workload updates, and potential issues to leadership and business partners as appropriate. You should expect to work in a fast-paced healthcare operations environment focused on claims research and resolution. You will utilize multiple systems and tools to investigate and process claim-related issues and collaborate with internal teams to ensure accurate and timely claim outcomes. You will handle sensitive and confidential information in accordance with company policies and procedures.
Requirements
- Experience in healthcare insurance, medical claims processing, claims resolution, or a related healthcare operations environment.
- Strong attention to detail, analytical thinking, and problem-solving skills.
- Ability to multitask, prioritize work, and meet deadlines in a fast-paced environment.
- Proficiency with Microsoft Office applications and the ability to navigate multiple systems to research and process claims.
- Strong written and verbal communication skills, along with the ability to interpret policies, procedures, and operational guidelines.
Responsibilities
- Review, research, and resolve medical and dental claims in accordance with established processing guidelines and procedures.
- Analyze claims issues and collaborate with internal departments to ensure timely and accurate resolution.
- Manage multiple priorities while maintaining productivity, accuracy, and service-level expectations.
- Communicate claim status, workload updates, and potential issues to leadership and business partners as appropriate.
Benefits
- flexible vacation policy
- 401(k) employer match
- comprehensive health benefits
- educational assistance
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
