Medical Claims Specialist - Remote WV

Date: Sep 29, 2025

Location:

Any city, WV, US, 99999

Req ID: 32416

Work Mode: Virtual (Exception only)

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

The Claims Examiner is responsible for reviewing, evaluating, and processing claims in accordance with policy provisions, regulatory requirements, and organizational guidelines. This role ensures timely, accurate, and fair adjudication of claims while maintaining a high level of customer service and compliance.

Your role in our mission

Review and analyze claims, documentation, and policy details to determine eligibility, coverage, and benefits.
Request additional information as needed and ensure claims meet company policies and regulatory standards.
Calculate and authorize accurate claim payments while maintaining detailed and organized records.
Communicate determinations clearly to policyholders, providers, and internal stakeholders, escalating complex or suspicious cases.
Meet service-level timelines, collaborate across departments, and stay current on regulations and best practices.

What we're looking for

High school diploma required; Associate’s or Bachelor’s degree preferred.
Two or more years of experience in claims processing or the insurance industry preferred.
Strong understanding of claims adjudication processes, policies, and regulatory standards.
Excellent analytical, problem-solving, and communication skills with strong attention to detail.
Proficient in claims management systems and Microsoft Office applications.

What you should expect in this role

This position is for residents of West Virginia.

This is a 100% remote position.

The starting pay rate for this position is $16.00/hour.

#LI-REMOTE #LI-PP1

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 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.