Claims Examiner - Remote Wisconsin

Job title: Claims Examiner - Remote Wisconsin in Wisconsin at Gainwell Technologies

Company: Gainwell Technologies

Job description: It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you've honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you'll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.SummaryYour role in our missionEssential Job Functions

• Enters insurance claims received electronically or in written form.


• Answers incoming customer calls regarding claim processing. Documents claim and associated history.


• Evaluates available information to validate claims. Verifies policyholder information, policy effective dates, premium status and verification of claim eligibility.


• Sends claim form to claimant for updating, correction or completion.


• Investigates simple to moderately complex claims and determines level or resolution if appropriate; advises claimant of status; assists in negotiating settlement and resolution of claim.


• Identifies need for additional information; contacts appropriate source to obtain needed information. Verifies beneficiary or claimant information if claim is warranted. Identifies payment amount and obtains required management approvals for payment. Processes payment.

Basic Qualifications

• High school diploma or G.E.D.


• Fellowship of Life Health Claims (FLHC) Certification preferred


• Two or more years of auditing, accounting, contracts or information technology experience


• Experience working with insurance and/or medical terminology


• Experience working with appropriate claims processing procedures and documentation

Other Qualifications

• Good analytical and problem solving skills


• Good interpersonal skills to interact with team members


• Good communication skills to communicate with clients


• Good data entry skills


• Negotiation skills to interact with claimant


• Ability to keep sensitive and confidential material private


• Ability to work in a team environment

Work Environment

• Office environment

What we're looking forWhat you should expect in this roleCompetency1Competency2Competency3Competency4Competency5The pay range for this position is $30,500.00 - $43,500.00 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 , 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 and visit our 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.

Expected salary: $30500 - 43500 per year

Location: Wisconsin

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