[Hiring] Claims Examiner @Gainwell Technologies LLC

Role Description

Be part of a team that’s making a difference in healthcare! As a Claims Examiner, you’ll play an important role in reviewing, researching, and processing insurance claims while ensuring accuracy, compliance, and timely resolution. This remote opportunity is ideal for someone who enjoys problem-solving, working with detailed information, and contributing to efficient healthcare and insurance operations.

• Review, evaluate, and process insurance claims received electronically or through written documentation, ensuring accuracy and compliance with established policies and procedures.
• Verify insurance eligibility, coverage information, policy details, and supporting documentation to determine appropriate claim processing and resolution.
• Research claim discrepancies, investigate processing issues, and identify necessary corrections, adjustments, or additional information needed to resolve claims.
• Respond to claim-related inquiries from customers, providers, and internal teams while maintaining accurate records and documentation.
• Manage assigned claims workloads, meet established productivity and quality standards, and escalate complex claims or discrepancies requiring additional review or approval.

Qualifications

• High school diploma or GED required; additional education or training in healthcare administration, insurance, or a related field preferred.
• Two or more years of experience in insurance claims processing, healthcare operations, administrative support, or a related field.
• Knowledge of insurance terminology, claims processing procedures, eligibility verification, and coverage requirements.
• Strong analytical, organizational, and problem-solving skills with excellent attention to detail and accuracy.
• Proficiency with computer applications, data entry, and Microsoft Office, with the ability to navigate multiple systems and communicate effectively.

Requirements

• A full-time, remote U.S. opportunity supporting healthcare and insurance claims processing operations.
• A non-exempt position with an established work schedule, productivity expectations, and quality performance standards.
• Daily responsibilities involving claims research, documentation, data accuracy, and collaboration with internal teams.
• A professional environment where confidentiality, information security, and proper handling of sensitive information are essential.

Benefits

• Access to Gainwell benefits, including medical, dental, and vision coverage.
• A 401(k) with company matching eligibility after 90 days.
• Paid holidays, including floating holidays.
• Professional development opportunities through Gainwell University.
• Generous, flexible vacation policy.
• Comprehensive health benefits and educational assistance.
• A variety of leadership and technical development academies to help build your skills and capabilities.