Healthcare Claims Resolution Specialist - Remote US Job Details | Gainwell Technologies LLC

Summary

Gainwell Technologies provides healthcare technology and business solutions. The Healthcare Claims Resolution Specialist supports cost recovery by researching and resolving claims, denials, and reimbursement issues with providers, carriers, and internal teams while ensuring compliance with Medicaid and payer requirements.

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

• 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

Qualifications

Must Haves

• 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

Benefits

• Remote-based role
• Work flexibility
• Learning and career development
• All salaried, full-time candidates are eligible for our generous, flexible vacation policy
• 401(k) employer match
• Comprehensive health benefits
• Educational assistance
• A variety of leadership and technical development academies to help build your skills and capabilities