Casualty Case Management (Work From Home, USA)

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

• Provide enrollment assistance and HIPP / Premium Assistance program information over the phone to Medicaid eligible recipients and their family members.
• Verify, document and investigate the presence of health care coverage for Medicaid recipients and their families.
• Assist in the identification of members that may qualify for the HIPP / Premium Assistance program.
• Complete periodic reports.
• Customer service to include high volume of phone work answering questions and other inquiries regarding the HIPP / Premium Assistance program.
• Data entry to include accurate and timely entry of information.
• Obtain and / or verify all items related to eligibility and enrollment into the HIPP / Premium Assistance program.
• Complete maintenance of active cases during open enrollment and premium review for check processing to assist with maintaining the revenue and program growth.

What We're Looking For

• Ability to organize well.
• Strong Customer Service Skills
• Strong Communication Skills
• Ability to provide and represent professionalism in job.
• Ability to practice flexibility and adaptability in the workplace.
• Ability to work with Microsoft Word and Excel and navigate internet skillfully.
• Ability to analyze information and use logic and process to address work-related issues and problems.
• Ability to operate with strong interpersonal skills.
• Ability to be careful and thorough about detail.
• Ability to perform data entry accurately.
• Average manual dexterity in use of a PC, phone, 10 key, sorting, filing and other office machines.
• Ability to handle conflict appropriately and constructively.
• Working knowledge of HIPAA privacy and Security rules.
• Ability to perform well in team environment.
• Ability to meet deadlines.
• Ability to handle pressure and deadline-oriented project demands.
• 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

Remote All USA Locations

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The pay range for this position is $26,500.00 - $37,800.00 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.