Call Center Agent - Provider Lead EDI - Remote CA

Gainwell Technologies; West Sacramento (CA); Remote; USD 36,000 - 51,000; Full time

Benefits offered by this job

Generous vacation policy

401(k) with match

Comprehensive health benefits

Educational assistance

Job summary

Gainwell Technologies is seeking a dedicated EDI and healthcare claims support professional to assist providers, billing offices, and trading partners with Provider Portal and EDI workflows.

The role involves investigating 837/835/270/271/276/277/278 transactions, assisting with enrollment and testing, and documenting resolutions in the CRM system. Remote-friendly with emphasis on strong communication and analytical skills.

Qualifications

• Experience with healthcare claims processing and HIPAA-compliant EDI transactions preferred.
• Ability to interpret EDI files, rejection reports, and transaction acknowledgments.
• Strong analytical, troubleshooting, and problem-solving skills; excellent communication skills.
• Experience using ticketing and CRM systems.

Responsibilities

• Provide technical support to healthcare providers, billing offices, and trading partners regarding Provider Portal and EDI functionality.
• Investigate EDI transaction issues (claims, eligibility, remittance, enrollment).
• Support enrollment, testing, setup, and connectivity; analyze rejections and error reports for root causes.
• Document interactions, troubleshooting steps, resolutions, and escalations in CRM.
• Navigate and communicate effectively with internal teams and external partners.

Skills

Healthcare claims

EDI transactions

CRM systems

Analytical skills

Communication skills

Tools

CRM software

Ticketing system

Microsoft Office

Job description

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

Your role in our mission

• Provide technical support to healthcare providers, billing offices, and trading partners regarding Provider Portal and EDI functionality.
• Investigate Electronic Data Interchange (EDI) transaction issues involving claim submissions, claim acknowledgments, eligibility requests (270/271), claim status requests (276/277), remittance transactions (835), and enrollment requests.
• Support providers and trading partners with EDI enrollment, testing, setup, and connectivity requirements. This includes analyzing EDI rejections, edits, and error reports to determine root causes and provide resolution guidance.
• Research provider and submitter calls/inquiries and responds to appropriate parties in accordance with service level agreements (SLAs).
• Document all interactions, troubleshooting steps, resolutions, and escalations in the customer relationship management (CRM) ticketing solution,

What we're looking for

• Knowledge of healthcare claims processing and provider operations; and understanding of HIPAA-compliant EDI transactions (837, 835, 270/271, 276/277, 278) strongly preferred
• Experience supporting web-based applications, provider portals, or healthcare technology platforms; ability to interpret EDI files, rejection reports, and transaction acknowledgments.
• Strong analytical, troubleshooting, and problem-solving skills; as well as excellent verbal and written communication skills.
• Experience using ticketing and customer relationship management (CRM) systems.
• Strong customer service orientation with a focus on provider satisfaction and issue resolution.

What you should expect in this role

• Business and analytical problem-solving skills.
• Communication skills written and oral.
• Ability to work independently and follow oral and written instructions.
• Ability to navigate Microsoft Word, Microsoft Teams, Microsoft Outlook, and internet browsers.
• Office environment
• Training will be delivered remotely

This position will be posted until October 15, 2026.

#LI-REMOTE

#LI-MA1

The pay range for this position is $35,900.00 - $51,300.00 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 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.