Claims Analyst - Remote US

Gainwell Technologies; Town of Texas (WI); Remote; USD 60,000 - 80,000; Full time

Job summary

Gainwell Technologies is seeking a detail-oriented Claims Analyst to join their remote team. This role involves analyzing pharmacy claims, preparing documentation, and collaborating with stakeholders to ensure accurate claim processes. The position offers opportunities for career growth in a supportive work environment that values flexibility and continuous learning.

Benefits

Flexible vacation policy

401(k) employer match

Comprehensive health benefits

Educational assistance

Leadership and technical development academies

Qualifications

• Minimum of 2 years in claims processing, analysis, auditing, or PBM operations.
• Strong working knowledge of pharmacy claims and adjudication systems.
• Experience preparing documentation and training materials.

Responsibilities

• Analyze pharmacy claims before payment to ensure accuracy and compliance.
• Prepare documentation, including manuals, policies, workflows, and educational materials.
• Collaborate with cross-functional teams to improve claims adjudication processes.

Skills

Analytical skills

Attention to detail

Communication

Problem-solving

Education

Bachelor's or Master's degree in Business, Healthcare, Audit, Insurance, or related field

Tools

Microsoft Outlook

Microsoft Excel

Microsoft Word

Microsoft PowerPoint

Job description

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Claims Analyst - Remote US

Date: May 19, 2025

Location:

Any city, TX, US, 99999

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.

Summary

Gainwell Technologies is looking for a highly analytical and detail-orientedClaims Analyst to join our remote team. This position supports prepayment claims analysis and report development for pharmacy claims under the guidance of the Claims Manager. You will work with internal stakeholders and external clients to ensure accurate claim submission and payment processes, while also contributing to continuous improvement through documentation, training, and system enhancements.

Your role in our mission

As a Professional Claims Analyst, you will:

Analyze pharmacy claims before payment to ensure accuracy and compliance.

Assist in identifying and recovering overpayments or pricing errors.

Prepare documentation, including manuals, policies, workflows, and educational materials.

Develop and present recurring and ad-hoc data reports to internal and external stakeholders.

Respond to claim inquiries from clients, pharmacies, and internal departments.

Collaborate with cross-functional teams to improve claims adjudication processes and system performance.

What we're looking for

Bachelor's or Master's degree in Business, Healthcare, Audit, Insurance, or related field, or equivalent experience.

Minimum of 2 years in claims processing, analysis, auditing, or PBM operations; Medicaid experience preferred.

Strong working knowledge of pharmacy claims, adjudication systems, and benefit configuration.

Experience preparing documentation and training materials for internal and external audiences.

National pharmacy technician certification and 2+ years of claims auditing experience preferred.

Proficient in Microsoft Outlook, Excel, Word, and PowerPoint.

What you should expect in this role

100% remote, work-from-home position based in the U.S.

Regular collaboration with internal teams and external clients.

Must maintain reliable high-speed internet connection.

Opportunity to support continuous process improvement and contribute to special projects.

#LI-REMOTE

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The pay range for this position is$47,000.00-$67,200.00 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 committed to a diverse, equitable, and inclusive workplace. We are proud to be 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), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.