Claims Analyst - Remote US - Jobs via Dice : Job Details

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Gainwell Technologies is seeking a highly analytical and detail-oriented Claims Analyst to join our remote team. This role involves supporting prepayment claims analysis and report development for pharmacy claims under the guidance of the Claims Manager. You will collaborate with internal stakeholders and external clients to ensure accurate claim submission and payment processes, contributing to ongoing improvements through documentation, training, and system enhancements.

• Analyze pharmacy claims before payment to ensure accuracy and compliance.
• Assist in identifying and recovering overpayments or pricing errors.
• Prepare documentation, including manuals, policies, workflows, and educational materials.
• Develop and present data reports to internal and external stakeholders.
• Respond to claim inquiries from clients, pharmacies, and internal departments.
• Collaborate with cross-functional teams to improve claims adjudication processes and system performance.

• Bachelor's or Master's degree in Business, Healthcare, Audit, Insurance, or related field, or equivalent experience.
• Minimum of 2 years in claims processing, analysis, auditing, or PBM operations; Medicaid experience preferred.
• Strong knowledge of pharmacy claims, adjudication systems, and benefit configuration.
• Experience preparing documentation and training materials for internal and external audiences.
• National pharmacy technician certification and 2+ years of claims auditing experience preferred.
• Proficiency in Microsoft Outlook, Excel, Word, and PowerPoint.

• 100% remote, work-from-home position based in the U.S.
• Regular collaboration with internal teams and external clients.
• Reliable high-speed internet connection required.
• Fast-paced, deadline-driven environment.
• Opportunities to support process improvements and contribute to projects.

The pay range is $47,000 - $67,200 annually, with variations based on location, experience, and other factors. Gainwell offers a comprehensive benefits package, including flexible vacation, 401(k) match, health benefits, and educational support. We foster a culture of collaboration, innovation, and inclusion, dedicated to making healthcare better for everyone.

Gainwell is an Equal Opportunity Employer committed to diversity and inclusion. All qualified applicants will receive consideration without regard to race, religion, gender, or other protected characteristics.