Medical Claims Resolution Analyst - Remote US

About the role

Gainwell Technologies is responsible for Claims Operations and Management functions supporting Medical Assistance Services programs. As a Claims Resolution Analyst, you will play a key role in researching, resolving, and processing provider claims while ensuring accuracy, compliance, and exceptional customer support.

Responsibilities

• 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.

Qualifications

Standard work schedule of Monday through Friday, 8:00 AM to 5:00 PM.

Skills

• Microsoft Office applications proficiency.
• Ability to navigate multiple systems to research and process claims.
• Strong written and verbal communication skills.
• Interpretation of policies, procedures, and operational guidelines.

Benefits

• Generous, flexible vacation policy.
• 401(k) employer match.
• Comprehensive health benefits.
• Educational assistance.

Pay

The pay range for this position is $35,000 - $50,000 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

Standard work schedule of Monday through Friday, 8:00 AM to 5:00 PM.