Claims Resolution Representative Hybrid Warwick, RI

Summary

Perform routine but moderately complex tasks related to healthcare policy and claims processing including prior authorizations, third-party liability, and manual pricing. Research and resolve customer questions or management requests utilizing policy manuals. Ensure claims are processed according to state and federal regulations while meeting contractual obligations. Resolve most problems and escalate only the most complex issues to immediate supervisor.

• Preparing correspondence
• Report preparation
• Verifying data
• Researching
• Completing forms
• Data entry

Involved in the training of new employees and may take the lead in areas of expertise.

Your Role in Our Mission

• Suspend medical claims using Medical Assistance Policy
• Entry and/or approval of medical Prior Authorizations
• Entry and maintenance of third-party insurance information to facilitate coordination of benefits and benefit recovery
• Identification of accident-related claims
• Research, entry, and maintenance of HCPC and CPT codes
• Entry of nursing home, hospital, federally qualified health centers, and ambulatory surgical center rates

What We're Looking For

• Typically requires 3 – 5 years general experience, or equivalent combination of experience and college-level education
• Healthcare, insurance, or third-party billing experience helpful
• Self-motivated with excellent time management and organizational skills; ability to work independently
• Experience with Microsoft Outlook, Word, and proficiency with Excel
• Ability to interpret healthcare policy, laws, and regulations

What You Should Expect in This Role

On-site environment located in Warwick, RI. Hybrid possible after training.

The pay range for this position is $30,500.00 - $43,500.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.

#LI-Hybrid

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About the Role

Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development.

Benefits

All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

Equal Opportunity Employer

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth.

We are committed to creating a diverse and inclusive workplace. Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.”