Claims Resolution Analyst Remote-Vermont

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 Resolution Analyst is responsible for reviewing and researching suspended claims, identifying and resolving issues and ensuring claims are processed in accordance with DVHA guidelines. This role involves analyzing claims data, coordinating with other departments and maintaining documentation to support accurate and timely claims resolution.

Your role in our mission

1. Review and research suspended claims per DVHA guidelines.
2. Refer claims to the appropriate department for further review when necessary.
3. Process claim adjustments and corrections as needed.
4. Prepare and issue Return to Provider (RTP) notices for incomplete or incorrect claims.
5. Maintain and update claims resolution procedure documentation.

What we're looking for

1. Train backup or replacement staff as needed.
2. Perform other duties as assigned.
3. Strong attention to detail and accuracy in claims processing.
4. Strong reading comprehension skills with the ability to interpret guidelines, policies, and procedures.
5. Proficiency in Microsoft Excel and Outlook, along with strong oral and written communication skills and the ability to adapt to changing priorities.

What you should expect in this role

This role plays a crucial part in ensuring claims are processed accurately and efficiently, contributing to the overall success of the claims team.

40 hours a week starting between 5:00 AM and 8:00 AM with a 30 minitue lunch break.

Remote

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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.