Medical Claims Resolution Analyst

🕒 July 15

🦬 Montana – Remote

🦬 Montana – Remote

💵 $35k - $50k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

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Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

📦 Logistics

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Consulting • Logistics • Healthcare Insurance

Gainwell Technologies is the nation’s leading provider of digital and cloud-enabled solutions across the human services and public health ecosystem. With a mission-driven approach, Gainwell serves clients in all 50 U. S. states, focusing on improving health outcomes and delivering intuitive, human-centered experiences. Their comprehensive suite of solutions includes Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions, all designed to advance the future of healthcare and enhance community well-being.

📋 Description

• Researching, resolving, and processing provider claims while ensuring accuracy, compliance, and exceptional customer support. • 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.

🎯 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.

🏖️ Benefits

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