[Hiring] Claims Resolution Analyst @Gainwell Technologies LLC

Role Description

The Claims Resolution Analyst is responsible for reviewing and researching suspended claims, identifying and resolving issues and ensuring claims are processed in accordance with DVHA guidelines. This role involves analyzing claims data, coordinating with other departments and maintaining documentation to support accurate and timely claims resolution.

• Review and research suspended claims per DVHA guidelines.
• Refer claims to the appropriate department for further review when necessary.
• Process claim adjustments and corrections as needed.
• Prepare and issue Return to Provider (RTP) notices for incomplete or incorrect claims.
• Maintain and update claims resolution procedure documentation.

Qualifications

• Strong attention to detail and accuracy in claims processing.
• Strong reading comprehension skills with the ability to interpret guidelines, policies, and procedures.
• Proficiency in Microsoft Excel and Outlook.
• Strong oral and written communication skills.
• Ability to adapt to changing priorities.

Requirements

• Train backup or replacement staff as needed.
• Perform other duties as assigned.

Benefits

• Generous, flexible vacation policy.
• 401(k) employer match.
• Comprehensive health benefits.
• Educational assistance.
• Variety of leadership and technical development academies to help build your skills and capabilities.

Company Description

Gainwell Technologies is 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), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.