Professional Claims Analyst

This is a fully remote position, open to applicants in Texas.

📋 Description

• Support the Claims Manager in the daily operations of the Claims Team.

• Offer training and mentorship to team members.

• Address claims issues by investigating specific claim scenarios.

• Produce necessary client reports and assist with audits.

• Contribute to special projects and overarching team objectives.

• Investigate and evaluate paid and denied claims, as well as issues related to the POS system and pricing discrepancies.

⛳️ Requirements

• Bachelor's degree in insurance, business administration, or a related discipline.

• At least three years of experience in claims.

• Familiarity with standard claims processing systems and investigative tools used in the industry.

• Understanding of claims processing protocols and documentation standards.

• Capability to operate under tight deadlines, manage various tasks, and work independently.

• Exceptional analytical, organizational, and problem-solving abilities.

• Necessary knowledge of pharmacy claims payment configuration processes and systems.

• Proficient in pharmacy claims processing.

• Prior experience with Medicaid is preferred.

• Strong written and verbal communication skills are essential.

• General proficiency in computer applications, including Microsoft Office and Excel.

• Certification as a Nationally Certified Pharmacy Technician is required.

🏝️ Benefits

• Access to Gainwell’s extensive benefits package based on eligibility criteria.

• Medical coverage.

• Dental insurance.

• Vision benefits.

• 401(k) plan.

• Additional employee programs.

• Flexible vacation policy.

• Educational assistance.

• Opportunities for various leadership and technical development academies.