Claims Examiner - Remote US

Gainwell Technologies LLC; Wisconsin; Remote; USD 31,000 - 44,000; Full time

Benefits offered by this job

Medical benefits

401(k) with company match

Paid holidays and floating holidays

Gainwell University - professional dev

Job summary

Gainwell Technologies LLC is seeking a Claims Examiner for a fully remote U.S. role. You will review and process insurance claims, verify eligibility, and ensure compliance with policies while collaborating with internal teams.

The ideal candidate has 2+ years in claims processing, strong analytical skills, and proficiency with Microsoft Office. This is a full-time remote position with benefits and career development opportunities.

Qualifications

• High school diploma or GED required; additional education in healthcare or insurance preferred.
• Two+ years of experience in insurance claims processing or healthcare operations.
• Knowledge of insurance terminology, eligibility verification, and coverage requirements.
• Strong analytical, organizational, and problem-solving skills with high attention to detail and accuracy.
• Proficiency with computer applications and Microsoft Office; ability to navigate multiple systems.

Responsibilities

• Review, evaluate, and process insurance claims received electronically or in writing, ensuring accuracy and policy compliance.
• Verify insurance eligibility, coverage, and policy details to determine processing and resolution.
• Research discrepancies, investigate processing issues, and request corrections or additional information as needed.
• Respond to claim inquiries from customers, providers, and internal teams with accurate documentation.
• Manage assigned claims workloads, meet productivity and quality standards, and escalate complex cases when needed.

Skills

Attention to detail

Policy knowledge

Microsoft Office

Claims processing

Analytical skills

Education

High school diploma or GED

Tools

None

Job description

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Location: Any city, WI, US, 99999

Work Mode: Virtual (Exception only)

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

Be part of a team that’s making a difference in healthcare! At Gainwell Technologies, we support healthcare operations through innovative technology and reliable services. 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.

Your role in our mission

• 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 escalation of complex claims or discrepancies requiring additional review or approval.

What we're looking for

• 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.

What you should expect in this role

• 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.
• 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; and professional development opportunities through Gainwell University.

#LI-REMOTE

#LI-JT1

The pay range for this position is$30,500.00-$43,500.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. 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.