Medical Claims Resolution Analyst - Remote US

Gainwell Technologies LLC•Any city, OH

6d•$35,000 - $50,000•Remote

About The Position

Gainwell Technologies is responsible for Claims Operations and Management functions supporting 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. Help create the power in Gainwell's processes as we develop purpose-built technologies and solutions that yield better health and human services outcomes.

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 claims in accordance with established processing guidelines and procedures.
Analyze claims issues and coordinate with internal departments to ensure timely and accurate resolution.
Prepare and process claim-related documentation, including Return to Provider (RTP) forms when required information is missing or invalid.
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.
Work in a fast-paced healthcare operations environment focused on claims research and resolution.
Utilize multiple systems and tools to investigate and process claim-related issues.
Collaborate with internal teams to ensure accurate and timely claim outcomes.
Handle sensitive and confidential information in accordance with company policies and procedures.