Claims Resolution Representative - REMOTE-PA

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

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.

Gainwell Technologies is responsible for all Claims Operation and Management functions of Medical Assistance Services. The primary role of a Claims Resolution Specialist is to provide exceptional customer support for incoming and outgoing Provider Claims processing.

Your role in our mission

Help create the power in Gainwell’s processes as we develop purpose-built technologies and solutions that yield better health and human services outcomes.

• Review and research claims based on claims processing guidelines.
• Refer claims to the appropriate department.
• Prepare Return to Provider (RTP) forms as necessary when required claim information is missing or invalid.
• Self-motivated with good time management and organization skills.
• Ability to work with several different teams, tasks, and completing deadlines to ensure all work is completed accurately.

What we're looking for

• Knowledge of the fundamental concepts and principles in the medical and / or insurance fields
• Basic reading and analysis skills to evaluate claims and make adjudication decisions
• Basic computer use skills
• Ability to multi-task across multiple claims to work efficiently
• Ability to work independently to meet individual production goals

What you should expect in this role

• Strong analytical and problem-solving skills
• Strong communication skills to communicate with clients.
• Ability to keep sensitive and confidential material private.
• Candidate must be able to come into the office for 2 weeks of training.
• The starting hours would be 8 am to 5 pm, Monday through Friday.
• REMOTE

LI-REMOTE #LI-JW1

The pay range for this position is $35,000.00 - $50,000.00 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.