Onsite Medical Claims Appeals Examiner (West Sacramento)

Gainwell Technologies; West Sacramento (CA); On-site; USD 38,000 - 54,000; Full time

Benefits offered by this job

401(k) employer match

Health benefits

Educational assistance

Flexible vacation policy

Professional development academies

Job summary

Gainwell Technologies in West Sacramento, CA, is seeking a Medical Claims Appeals Examiner for an onsite role with a 6:00 a.m. to 2:30 p.m. schedule.

The position focuses on reviewing, researching, and resolving provider appeals related to medical claims and payment determinations. Ideal candidates will have 2+ years of medical claims or appeals experience, strong attention to detail, and proficiency with Microsoft Outlook, Word, Excel, Teams, and health insurance terminology.

Qualifications

• Two or more years of medical claims and/or appeals experience required.
• Experience researching and resolving healthcare claim payment issues.
• Experience working with health insurance and medical terminology.
• Strong research, analytical, and problem-solving skills with attention to detail.

Responsibilities

• Review and research provider appeals using established guidelines and document determinations clearly, accurately, and concisely.
• Analyze medical claims, appeal documentation, payment information, and supporting records to ensure all aspects of an appeal are addressed.
• Research and resolve claim payment issues, identifying discrepancies and determining appropriate actions.
• Resubmit or adjust claims for approved appeals with proper documentation.
• Maintain productivity, accuracy, and quality standards while managing appeals through resolution.
• Protect confidential information and comply with HIPAA and regulatory requirements.

Skills

Medical claims

Appeals experience

Research

Analytical skills

Microsoft Outlook

Microsoft Word

Microsoft Excel

Microsoft Teams

Health insurance terminology

Tools

MS Office

Job description

Gainwell Technologies in West Sacramento, CA, is seeking a Medical Claims Appeals Examiner for an onsite role with a 6:00 a.m. to 2:30 p.m. schedule.

The position focuses on reviewing, researching, and resolving provider appeals related to medical claims and payment determinations. Ideal candidates will have 2+ years of medical claims or appeals experience, strong attention to detail, and proficiency with Microsoft Outlook, Word, Excel, Teams, and health insurance terminology.