Senior Assistant Claims Examiner - Hybrid- Phoenix, Arizona

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.

Summary

HMS makes the healthcare system work better for everyone. We fight fraud, waste, and abuse so

people have access to healthcare-now and in the future. Using innovative technology and

powerful data analytics, we help government and commercial payers reduce costs, increase.

quality, and achieve regulatory compliance. We also help consumers take a more active role in

their own health. Each year, we save our clients billions of dollars while helping people live.

healthier lives. At HMS, you will develop new skills and build your career in a dynamic industry.

while making a difference in the lives of others.

We are seeking a talented individual for an Eligibility Operations Advisor I who is responsible for

verifying, documenting and coordinating information needed to process applications and other

Eligibility Operations assignments. Conducts health insurance policy analysis, documentation

verification, employer coordination and customer service while ensuring accurate data entry,

validation and timely processing.

Your Role in Our Mission

• Interact professionally (i.e. on incoming and outgoing calls) with attorneys, insurance adjusters, medical providers, court staff, recipients and family members and client.
• Effectively maintain and manage a variety of cases with current and accurate notes from creation to recovery
• Maintain a daily system of providing timely and accurate information required to move cases through the case management workflow.
• Daily telephone contact with counterparties, including attorneys, adjusters and healthcare providers
• Independently work cases of high dollar value up to and through settlement.
• Confirm and validate third party liability and, probate and beneficiary asset research.
• Prepare required correspondence, liens, claims and other related documents to progress the case to recovery.
• Negotiate and compromise claim / lien settlement amounts per contract guidelines.
• Process all claim / lien disputes and review claims with attorneys and other stakeholders.
• Conduct outgoing follow up on case status and payment.

What We're Looking For

• Ability to interact with all levels of people both internally and externally in a professional manner.
• Ability to be careful and thorough about detail including with cite-checking and proof-reading skills.
• Ability to multi-task and prioritize effectively.
• Ability to work proficiently with Microsoft Office, PowerPoint, Word, and Excel required
• Ability to work independently to meet objectives.
• Ability to analyze information and use logic to address work-related issues and problems.
• Ability to perform well in team environment, to achieve business goals.
• Ability to maintain a high level of confidentiality and ethics.
• Ability to handle pressure and manage deadline oriented project demands and multiple initiatives.
• Min. 2 year of experience in insurance industry, health care or government sponsored.
• math related experience.
• Min. 2-year experience working on the phone making inquiries (outbound) and answering calls (inbound).
• MassHealth Experience Preferred
• Call Center Experience Preferred
• Human Resources or Health Insurance Experience preferred.
• Knowledge of health care terminology is a plus.

What Should you Expect in this Role

Onsite in Phoenix, Arizona for training purposes. Once training is complete, position is hybrid.

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he 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.

Put your passion to work at Gainwell. You'll have the opportunity to grow your career in a company that values work flexibility, learning, and career development.

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.

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.

Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is committed to a diverse, equitable, and inclusive workplace. We are proud to be 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), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.

We celebrate diversity and are dedicated to creating an inclusive environment for all employees.