[Hiring] Claims Resolution Specialist @Gainwell Technologies LLC

Role Description

The primary role of a Claims Resolution Specialist is to provide exceptional customer support for incoming and outgoing Provider Claims processing.

• Review, research, and process claims in accordance with established claims processing guidelines.
• Refer claims to the appropriate department and prepare Return to Provider (RTP) forms when required information is missing or invalid.
• Demonstrate strong time management, organizational skills, and the ability to work independently in a fast-paced environment.
• Collaborate effectively across multiple teams while managing competing priorities and meeting established deadlines.
• Maintain accurate workload tracking and communicate status updates, challenges, and potential roadblocks to leadership in a timely manner.

Qualifications

• Strong attention to detail, accuracy, and commitment to maintaining a consistent work schedule.
• Ability to multitask effectively while demonstrating strong data entry and organizational skills, including knowledge of the Julian calendar.
• Proficiency in Microsoft Office Suite with excellent verbal and written communication skills.
• Experience using multiple systems to research, gather, and analyze information necessary for claims processing.
• Experience in healthcare insurance and/or medical claims, with the ability to read, interpret, and apply basic to moderately complex operating procedures and documentation.

Requirements

• Must reside in Pennsylvania to be eligible for this remote position.
• Availability to work a schedule of 8:00 AM to 5:00 PM, Monday through Friday.
• Strong analytical and problem-solving skills with the ability to make sound decisions and resolve issues effectively.
• Excellent interpersonal and communication skills, with the ability to collaborate with team members and interact professionally with clients.
• Ability to handle sensitive and confidential information with discretion and professionalism.

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.