Healthcare Claims Resolution Specialist - Remote US

Gainwell Technologies; Texas; Hybrid; USD 42,000 - 56,000; Full time

Job summary

Gainwell Technologies is seeking a Healthcare Claims Resolution Specialist to work remotely in the US. You will support cost recovery by researching provider claims, denials, and reimbursements, focusing on third-party billing, follow-up, and appeals while adhering to Medicaid and payer rules.

Ideal candidates have 1+ year in third-party billing, strong analytical skills, and proficiency with Office apps; must have a high school diploma and be able to work in a production-driven remote

Qualifications

• 1+ year of experience in third-party institutional billing, claims processing, or healthcare reimbursement.
• 1+ year of experience handling claim denials, appeals, and claim resolution activities.
• Ability to interpret Explanation of Benefits (EOB) documents and UB-04 claim forms.
• Strong analytical and critical-thinking skills with exceptional attention to detail.
• Proficiency with Microsoft Office applications, including Word, Excel, and Windows-based systems.

Responsibilities

• Contact and collaborate with provider offices to research, verify, and resolve claims, denials, and reimbursement-related issues.
• Review denied and unpaid claims, determine appropriate next steps, and pursue appeals as needed.
• Document all actions, outcomes, and claim activity within the case management system.
• Respond to carrier inquiries regarding outstanding claims and recovery efforts.
• Obtain supporting documentation from providers to facilitate claim resolution.
• Monitor and manage aging reports to ensure timely follow-up and reimbursement.
• Ensure compliance with timely filing requirements and payer regulations.
• Develop recovery strategies to maximize reimbursement opportunities across assigned claim inventories.
• Utilize document imaging systems for record retention and archival purposes.
• Partner with internal subject matter experts to resolve complex claims and reimbursement issues.
• Support project-based training initiatives and perform other duties as assigned.

Skills

Third-party billing

Claims processing

EOB/UB-04 interpretation

Analytical skills

MS Office proficiency

Education

High School Diploma/GED

Job description

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Healthcare Claims Resolution Specialist - Remote US

Date: Jul 30, 2026

Location: Any city, TX, US, 99999

Work Mode: Virtual (Exception only)

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

As a COB Service Representative Assistant at Gainwell, you will support cost recovery efforts by working with insurance carriers, providers, and internal teams to resolve claims and ensure proper reimbursement. This role focuses on third-party billing, claims follow-up, and appeals while ensuring compliance with Medicaid and payer guidelines. You will play a key role in maximizing recovery outcomes through effective communication, detailed analysis, and consistent follow-through.

Your role in our mission

• Contact and collaborate with provider offices to research, verify, and resolve claims, denials, and reimbursement-related issues.
• Review denied and unpaid claims, determine appropriate next steps, and pursue appeals as needed.
• Document all actions, outcomes, and claim activity within the case management system.
• Respond to carrier inquiries regarding outstanding claims and recovery efforts.
• Obtain supporting documentation from providers to facilitate claim resolution.
• Monitor and manage aging reports to ensure timely follow-up and reimbursement.
• Ensure compliance with timely filing requirements and payer regulations.
• Develop recovery strategies to maximize reimbursement opportunities across assigned claim inventories.
• Utilize document imaging systems for record retention and archival purposes.
• Partner with internal subject matter experts to resolve complex claims and reimbursement issues.
• Support project-based training initiatives and perform other duties as assigned.

What we're looking for

• High School Diploma/GED required.
• 1+ years of experience in third-party institutional billing, claims processing, or healthcare reimbursement.
• 1+ year of experience handling claim denials, appeals, and claim resolution activities.
• Ability to interpret Explanation of Benefits (EOB) documents and UB-04 claim forms.
• Strong analytical and critical-thinking skills with exceptional attention to detail.
• Proficiency with Microsoft Office applications, including Word, Excel, and Windows-based systems.

What you should expect in this role

• Remote-based role in a production-driven environment focused on claims recovery and resolution
• Standard 8-hour shift within business hours (7:00 AM – 4:30 PM)
• Daily work includes claim follow-up, appeals processing, documentation, and system updates
• Video cameras must be used during all interviews, as well as during the initial week of orientation.
• To work effectively as a teleworker or hybrid positions with Gainwell, employees must have a broadband internet connection with a minimum speed of 24 Mbps download and 8 Mbps upload. Higher speeds are recommended for optimal performance.
• To test your internet speed, go to Google and search for “Internet Speed Test.