Disability Claims Examiner - Remote US

Gainwell Technologies; Wisconsin; Remote; USD 54,000 - 78,000; Full time

Job summary

Join a forward-thinking company as a Disability Claims Examiner, where your analytical skills will help adjudicate disability claims for children. This role offers flexible hours and the chance to work remotely, ensuring you can balance your professional and personal life. You'll engage in meaningful work, assessing complex cases and collaborating with various stakeholders to improve healthcare access for children with disabilities. With a commitment to continuous learning and career development, this position is perfect for those looking to make a significant impact in the healthcare sector while enjoying a supportive work environment.

Benefits

Flexible vacation policy

401(k) employer match

Comprehensive health benefits

Educational assistance

Leadership development academies

Technical development academies

Qualifications

• 2+ years of clinical experience working with children who have disabilities.
• Experience with confidential records and protected information.

Responsibilities

• Adjudicate disability determinations for children applying to Medicaid.
• Review and evaluate medical and psychological disability cases.

Skills

Analytical Skills

Communication Skills

Attention to Detail

Documentation Accuracy

Clinical Experience

Education

Bachelor’s degree in a human-services field

Associate degree with relevant experience

Tools

CARES Worker Web

Job description

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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

Under the supervision of the Bureau of Clinical Policy and Pharmacy (BCPP) Clinical Policy Section Manager and the Katie Beckett Reviewer Lead, the Disability Claims Examiner role is responsible for adjudicating disability determinations for children applying to Wisconsin’s Katie Beckett Medicaid. The specialist will manage a caseload of medical and psychological evaluations—across initial, continuing, and appellate stages—ensuring timely, accurate documentation in accordance with the Social Security Disability Act. This individual will work remotely within the US. Employees are required to work six of their eight daily hours between 9:00 AM – 3:00 PM CST, Monday through Friday. The remaining two hours can be scheduled at their discretion. Initial training spans six weeks and focuses on reviewing redacted cases involving medical and educational disability evidence.

Your role in our mission

As a Disability Claims Examiner, you will:

Review and evaluate medical and psychological disability cases via CARES Worker Web (CWW).

Assess disability claims based on SSA disability regulations and functional limitations.

Request additional documentation when medical records are incomplete.

Prepare and submit thorough written evaluations, summaries, and recommendations.

Collaborate with internal reviewers, leads, and consultants to resolve case inconsistencies.

Respond to Privacy Act or FOIA requests within agency standards.

What we're looking for

Required Qualifications:

Bachelor’s degree in a human-services field with 2+ years of clinical experience working with children who have disabilities, OR associate degree with 5+ years of relevant experience.

Clinical background and strong analytical ability to assess complex cases.

Excellent verbal and written communication skills.

High attention to detail, timeline management, and documentation accuracy.

Experience working with confidential records and protected information.

Demonstrated computer proficiency and ability to work autonomously.

Preferred Qualifications:

Experience with CARES Worker Web.

Background in nursing, psychology, social work, or similar health-related disciplines.

Knowledge of Social Security Act disability guidelines and Medicaid programs.

Familiarity with electronic medical and evidentiary record systems.

Experience evaluating disability claims.

Exposure to public health initiatives or state-run clinical programs.

What you should expect in this role

This is a remote or work from home position based in the U.S.. To be able to do this you must have a minimum speed of 24MBS download and 8 MBS upload internet connection..

40-hour work week with required availability from 9:00 AM – 3:00 PM CST, Monday through Friday.

Flexible scheduling of remaining work hours each day.

Six-week remote training focused on disability case review and adjudication.

Opportunity to make a meaningful impact in improving access to healthcare services for children with complex needs.

#LI-REMOTE

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The pay range for this position is$54,300.00-$77,500.00 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 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.