Professional Claims Analyst

🕒 May 21

🤠 Texas – Remote

🤠 Texas – Remote

💵 $47k - $67.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

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Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Healthcare Insurance • Human Services • Healthcare

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

• Assist the Claims Manager with day-to-day Claims Team operations • Provide training and guidance to team members • Resolve claims issues by researching claim situations • Generate required client reporting and support audits • Assist with special projects and related team goals • Research and analyze paid and denied claims, POS system issues, and pricing discrepancies

🎯 Requirements

• Bachelor’s degree in insurance, business administration, or related field • Minimum three years of claims experience • Experience with industry-standard claims processing systems and investigative tools • Knowledge of claims processing procedures and documentation standards • Ability to work under tight deadlines, manage multiple responsibilities, and work independently • Strong analytical, organizational, and problem-solving skills • Required understanding of pharmacy claims payment configuration processes and systems • Required pharmacy claims processing knowledge • Medicaid experience preferred • Strong written and verbal communication skills • General computer proficiency including Microsoft Office and Excel • Nationally Certified Pharmacy Technician certification

🏖️ Benefits

• Access to Gainwell’s comprehensive benefits package in accordance with eligibility guidelines • medical • dental • vision • 401(k) • other employee programs • flexible vacation policy • educational assistance • various leadership and technical development academies