Appeals Examiner - Hybrid (Remote Eligible After 90 Days) - West Sacramento, CA

Gainwell Technologies; West Sacramento (CA); Ibrido; USD 38.000 - 54.000; Tempo pieno

Vantaggi offerti da questo lavoro

401(k) employer match

Comprehensive health benefits

Generous vacation policy

Educational assistance

Leadership and technical development  

Career development opportunities

Descrizione del lavoro

Gainwell Technologies in West Sacramento, CA, seeks an Appeals Examiner to review and resolve healthcare provider appeals related to medical claims and payment determinations. The role analyzes documentation, researches claim payment issues, and ensures accuracy per guidelines and regulatory requirements.

The ideal candidate has 2+ years in medical claims/appeals, strong attention to detail, and the ability to meet quality and productivity standards in a production environment.

Competenze

• Two or more years of medical claims and/or appeals experience.
• Experience researching and resolving healthcare claim payment issues.
• Experience working with health insurance and medical terminology.
• Strong research, analytical, and problem-solving skills with exceptional attention to detail and accuracy.
• Ability to interpret claims information, appeal documentation, policies, and procedures to determine appropriate resolution.
• Ability to work effectively in a production-focused environment while meeting established quality and productivity expectations.
• Proficiency with Microsoft Outlook, Word, Excel, Teams, and related business systems.

Mansioni

• Review and research provider appeals using established guidelines and document appeal determinations clearly, accurately, and concisely.
• Analyze medical claims, appeal documentation, payment information, and supporting records to ensure all aspects of an appeal have been appropriately addressed.
• Research and resolve claim payment issues, identifying discrepancies and determining appropriate actions based on established policies and procedures.
• Resubmit or adjust claims for approved appeals, ensuring appropriate claim corrections and supporting documentation are completed.
• Maintain established productivity, accuracy, and quality standards while managing assigned appeals through resolution.
• Protect confidential information and maintain compliance with HIPAA and applicable organizational and regulatory requirements.

Conoscenze

Medical claims experience

Appeals experience

Healthcare terminology

Research skills

Attention to detail

Strumenti

Microsoft Outlook

Excel

Word

Teams

Descrizione del lavoro

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Appeals Examiner - Hybrid (Remote Eligible After 90 Days) - West Sacramento, CA

Date: Oct 27, 2026

Location: West Sacramento, CA, US, 95605-1630

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

TheAppeals Examiner reviews, researches, and resolves healthcare provider appeals related to medical claims and payment determinations.

This role analyzes appeal documentation, researches claim payment issues, and ensures each appeal is reviewed accurately and completely in accordance with established guidelines, policies, and regulatory requirements. The ideal candidate brings strong medical claims or appeals experience, exceptional attention to detail, and the ability to consistently meet quality and productivity standards.

Your role in our mission

• Review and research provider appeals using established guidelines and document appeal determinations clearly, accurately, and concisely.
• Analyze medical claims, appeal documentation, payment information, and supporting records to ensure all aspects of an appeal have been appropriately addressed.
• Research and resolve claim payment issues, identifying discrepancies and determining appropriate actions based on established policies and procedures.
• Resubmit or adjust claims for approved appeals, ensuring appropriate claim corrections and supporting documentation are completed.
• Maintain established productivity, accuracy, and quality standards while managing assigned appeals through resolution.
• Protect confidential information and maintain compliance with HIPAA and applicable organizational and regulatory requirements.

What we're looking for

• Two or more years of medical claims and/or appeals experience required.
• Experience researching and resolving healthcare claim payment issues.
• Experience working with health insurance and medical terminology.
• Strong research, analytical, and problem-solving skills with exceptional attention to detail and accuracy.
• Ability to interpret claims information, appeal documentation, policies, and procedures to determine appropriate resolution.
• Ability to work effectively in a production-focused environment while meeting established quality and productivity expectations.
• Proficiency with Microsoft Outlook, Word, Excel, Teams, and related business systems.

What you should expect in this role

This position requires working onsite in West Sacramento, California, for the first 90 days.

After 90 days, employees may be eligible to transition to fully remote work (work from home), based on performance, productivity, quality standards, management approval, and business needs.

Work schedule: 6:00 a.m. to 2:30 p.m. Pacific Time.

Opportunity to support California's Medi-Cal program by ensuring provider appeals and medical claims are researched and resolved accurately and timely.

Applications for this position will be accepted through November 3, 2026.

#LI-ONSITE

#LI-M

• The pay range for this position is$37,500.00-$53,500.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.
• our generous, flexible vacation policy
• a 401(k) employer match
• comprehensive health benefits
• educational assistance
• leadership and technical development academies to help build your skills and capabilities

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.

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 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. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.