Claims Examiner Assistant Remote U.S.
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AI Summary
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
Your role in our mission
Essential Job Functions
- Enters insurance claims received electronically or in written form.
- Answers incoming customer calls regarding claim processing. Documents claim and associated history.
- Evaluates available information to validate claims. Verifies policyholder information, policy effective dates, premium status and verification of claim eligibility.
- Sends claim form to claimant for updating, correction or completion.
- Investigates simple to moderately complex claims and determines level or resolution if appropriate; advises claimant of status; assists in negotiating settlement and resolution of claim.
- Identifies need for additional information; contacts appropriate source to obtain needed information. Verifies beneficiary or claimant information if claim is warranted. Identifies payment amount and obtains required management approvals for payment. Processes payment.
Basic Qualifications
- High school diploma or G.E.D.
- Fellowship of Life Health Claims (FLHC) Certification preferred
- Two or more years of auditing, accounting, contracts or information technology experience
- Experience working with insurance and/or medical terminology
- Experience working with appropriate claims processing procedures and documentation
Other Qualifications
- Good analytical and problem solving skills
- Good interpersonal skills to interact with team members
- Good communication skills to communicate with clients
- Good data entry skills
- Negotiation skills to interact with claimant
- Ability to keep sensitive and confidential material private
- Ability to work in a team environment
Work Environment
- Office environment
What we're looking for
What you should expect in this role
The pay range for this position is $30,500.00 - $43,500.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. 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.
We believe 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.
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