Medical Claims Resolution Analyst - Remote US

Gainwell Technologies; United States; On-site; USD 35,000 - 50,000; Full time

Benefits offered by this job

Health benefits

401(k) match

Flexible vacation policy

Educational assistance

Job summary

Gainwell Technologies is seeking a Claims Resolution Analyst to research, resolve, and process provider claims with a focus on accuracy and compliance. You will support Medical Assistance Services programs and work with multiple systems to research and process claims.

This role operates in a fast-paced healthcare operations environment, requiring strong attention to detail, effective communication, and the ability to manage competing priorities.

Qualifications

• Experience in healthcare insurance, medical claims processing, or related healthcare operations.
• Strong attention to detail, analytical thinking, and problem-solving skills.
• Ability to multitask, prioritize work, and meet deadlines in a fast-paced environment.
• Proficiency with Microsoft Office and navigating multiple systems to research and process claims.
• Strong written and verbal communication skills and the ability to interpret policies and procedures.

Responsibilities

• Review, research, and resolve medical claims following processing guidelines.
• Analyze claims issues and coordinate with internal teams for timely resolution.
• Prepare and process claim documentation, including RTP forms when needed.
• Manage multiple priorities while maintaining productivity, accuracy, and SLAs.
• Communicate claim status and updates to leadership and business partners.

Skills

Healthcare claims experience

Claims processing

Attention to detail

Multitasking

Communication skills

MS Office proficiency

Tools

Microsoft Office

Job description

Overview

Gainwell Technologies is responsible for Claims Operations and Management functions supporting Medical Assistance Services programs. As a Claims Resolution Analyst, you will play a key role in researching, resolving, and processing provider claims while ensuring accuracy, compliance, and exceptional customer support.

Your role in our mission

Help create the power in Gainwell's processes as we develop purpose-built technologies and solutions that yield better health and human services outcomes.

Responsibilities

• Review, research, and resolve medical claims in accordance with established processing guidelines and procedures.
• Analyze claims issues and coordinate with internal departments to ensure timely and accurate resolution.
• Prepare and process claim-related documentation, including Return to Provider (RTP) forms when required information is missing or invalid.
• Manage multiple priorities while maintaining productivity, accuracy, and service-level expectations.
• Communicate claim status, workload updates, and potential issues to leadership and business partners as appropriate.

What We\'re Looking For

• Experience in healthcare insurance, medical claims processing, claims resolution, or a related healthcare operations environment.
• Strong attention to detail, analytical thinking, and problem-solving skills.
• Ability to multitask, prioritize work, and meet deadlines in a fast-paced environment.
• Proficiency with Microsoft Office applications and the ability to navigate multiple systems to research and process claims.
• Strong written and verbal communication skills, along with the ability to interpret policies, procedures, and operational guidelines.

What You Should Expect In This Role

• Work in a fast-paced healthcare operations environment focused on claims research and resolution.
• Utilize multiple systems and tools to investigate and process claim-related issues.
• Collaborate with internal teams to ensure accurate and timely claim outcomes.
• Handle sensitive and confidential information in accordance with company policies and procedures.
• Standard work schedule of Monday through Friday, 8:00 AM to 5:00 PM.
• This posting is intended for pipelining. We will accept applications on an ongoing basis.

Compensation and Benefits

The pay range for this position is $35,000 - $50,000 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. 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.

Gainwell believes 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.