Medical Claims Specialist - Remote WV

Gainwell Technologies LLC • OH

99d • $28,500 - $40,700

About The Position

The Claims Examiner is responsible for reviewing, evaluating, and processing claims in accordance with policy provisions, regulatory requirements, and organizational guidelines. This role ensures timely, accurate, and fair adjudication of claims while maintaining a high level of customer service and compliance.

Requirements

• High school diploma required; Associate’s or Bachelor’s degree preferred.
• Two or more years of experience in claims processing or the insurance industry preferred.
• Strong understanding of claims adjudication processes, policies, and regulatory standards.
• Excellent analytical, problem-solving, and communication skills with strong attention to detail.
• Proficient in claims management systems and Microsoft Office applications.

Responsibilities

• Review and analyze claims, documentation, and policy details to determine eligibility, coverage, and benefits.
• Request additional information as needed and ensure claims meet company policies and regulatory standards.
• Calculate and authorize accurate claim payments while maintaining detailed and organized records.
• Communicate determinations clearly to policyholders, providers, and internal stakeholders, escalating complex or suspicious cases.
• Meet service-level timelines, collaborate across departments, and stay current on regulations and best practices.

Benefits

• Generous, flexible vacation policy
• 401(k) employer match
• Comprehensive health benefits
• Educational assistance
• Leadership and technical development academies

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees