Claims Resolution Representative, Onsite Warwick, RI

About the role

Great companies need great teams to propel their operations. 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.

Responsibilities

• Perform routine but moderately complex tasks related to healthcare policy and claims processing including prior authorizations, third-party liability, and manual pricing.
• Apply knowledge of established procedures and policy to research and resolve customer questions or management requests utilizing policy manuals.
• Ensure that 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.
• Prepare correspondence, prepare reports, verify data, research, complete forms, and perform data entry.
• Perform other duties as assigned.
• Involved in the training of new employees and may take the lead in areas of expertise.
• Resolve suspended medical claims utilizing 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.

Requirements

Typically requires 3 – 5 years general experience, or equivalent combination of experience and college-level education. Healthcare, insurance, or third-party billing experience helpful.

Skills

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.

Benefits

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

Pay

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.

Schedule

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