Medical Claims Clerk - Remote WV

Date: Mar 18, 2025

Location:

Any city, WV, US, 99999

Req ID: 29815

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

A Claims Examiner is responsible for reviewing insurance claims to ensure accuracy, compliance, and adherence to company policies and regulations. They evaluate claims, determine coverage eligibility, and work with policyholders, healthcare providers, and other stakeholders to process claims efficiently.

Your role in our mission

Review and analyze insurance claims to determine validity and coverage eligibility.
Ensure claims comply with company policies, procedures, and regulatory guidelines.
Investigate discrepancies, gather additional information, and request necessary documentation.
Assess the extent of policy coverage and recommend claim approvals, denials, or adjustments.
Work closely with adjusters, policyholders, medical professionals, and legal teams as needed.
Identify potential fraud and escalate suspicious claims for further investigation.
Maintain accurate and detailed records of claim decisions and communication.
Provide customer service by addressing claim-related inquiries and resolving issues.
Stay updated on industry regulations, insurance policies, and best practices.
Assist in training new team members and contribute to process improvement initiatives.

What we're looking for

High school diploma or equivalent (Bachelor’s degree in business, finance, or a related field preferred).
Prior experience in claims processing, insurance, or a related field.
Strong analytical and problem-solving skills.
Excellent attention to detail and organizational abilities.
Effective communication and customer service skills.
Knowledge of insurance laws, policies, and industry regulations.

What you should expect in this role

Remote position
Monday – Friday (Standard business hours)
The candidate must be in WV or 30 miles of the border.

#LI-REMOTE #LI-JW1

The pay range for this position is $28,500.00 - $40,700.00 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 committed to a diverse, equitable, and inclusive workplace. We are proud to be 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), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.