Remote Healthcare Claims Recovery Specialist

Gainwell Technologies LLC; Austin (TX); Remote; USD 27,000 - 38,000; Full time

Benefits offered by this job

Educational assistance

Flexible vacation policy

Job summary

Gainwell Technologies LLC is hiring a Healthcare Claims Resolution Specialist for remote work in the United States. You will support cost recovery efforts by researching, verifying, and resolving claims, denials, and reimbursement-related issues with insurance carriers, providers, and internal teams.

This role emphasizes Medicaid and payer guidelines compliance. Responsibilities include reviewing denied claims, pursuing appeals when needed, documenting all actions in the case management system,

Qualifications

• 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 EOB documents and UB-04 claim forms.
• Strong analytical and critical-thinking skills with attention to detail.
• Proficiency with Word, Excel, and Windows-based systems.

Responsibilities

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

Skills

Third-party billing

Claims processing

Healthcare reimbursement

Denials & appeals

EOB interpretation

UB-04 forms

Analytical thinking

Attention to detail

MS Office proficiency

Education

High School Diploma or GED

Tools

Microsoft Office

Windows-based systems

Job description

Gainwell Technologies LLC is hiring a Healthcare Claims Resolution Specialist for remote work in the United States. You will support cost recovery efforts by researching, verifying, and resolving claims, denials, and reimbursement-related issues with insurance carriers, providers, and internal teams.

This role emphasizes Medicaid and payer guidelines compliance. Responsibilities include reviewing denied claims, pursuing appeals when needed, documenting all actions in the case management system,