Healthcare Claims Auditor

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

As a COB Claims Auditor, Associate at Gainwell, you will apply strong analytical skills and attention to detail to ensure insurance claims are accurate, compliant, and processed in accordance with policy guidelines and regulatory requirements. By auditing claim files, validating payment accuracy, and identifying discrepancies, you will help safeguard the integrity of the claims process and support positive outcomes for the communities we serve. In this role, you will collaborate closely with management and the claims processing team to ensure compliance with internal procedures and state and federal regulations.

Your Role in Our Mission

• Review and verify insurance claims for accuracy, completeness, and compliance with policy terms and regulatory requirements
• Audit claim files and analyze claim payment accuracy, including complex claims
• Review and interpret Explanation of Benefits (EOB), Explanation of Payment (EOP), and Remittance Advice documents
• Identify inconsistencies, discrepancies, or potential errors and escalate findings to the appropriate teams for resolution
• Ensure claim payments align with company procedures, contractual guidelines, and regulatory standards
• Collaborate with management and claims processing teams to research and resolve claim issues
• Maintain current knowledge of state and federal regulations related to insurance claims and compliance requirements
• Prepare audit documentation, reports, and summaries outlining findings and recommendations

What We’re Looking For

• Experience reviewing and verifying healthcare insurance claims for accuracy and compliance
• Experience reviewing and interpreting EOB/EOP and Remittance Advice
• Prior experience conducting claim audits or payment accuracy analysis
• Knowledge of state and federal insurance regulations and compliance standards
• Strong attention to detail with the ability to analyze complex information
• Effective written and verbal communication skills
• Ability to work independently in a remote environment while managing priorities and deadlines

What You Should Expect in This Role

• Remote position within the United States
• Standard business hours, Monday through Friday
• Collaborative environment working closely with claims processing and management teams
• Ongoing training and exposure to regulatory and compliance-driven workflows
• Video cameras must be used during all interviews, as well as during the initial week of orientation.
• To work effectively as a teleworker or hybrid positions with Gainwell, employees must have a broadband internet connection with a minimum speed of 24 Mbps download and 8 Mbps upload. Higher speeds are recommended for optimal performance.
• To test your internet speed, go to Google and search for “Internet Speed Test.”

The deadline to submit applications for this posting is January 21, 2025.

#LI-REMOTE #LI-JA1 #LI-CM1

The pay range for this position is $35,000.00 - $50,000.00 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.