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 supports 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, while contributing to continuous improvement 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 recurring and ad-hoc 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 working 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.
• Proficient 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.
• Must maintain reliable high-speed internet connection.
• Fast-paced, deadline-driven work environment.
• Opportunity to support continuous process improvement and contribute to special projects.

The pay range for this position is $47,000 - $67,200 per year, with variations based on geographic region, experience, and other factors. Gainwell offers a comprehensive benefits package, including flexible vacation, 401(k) match, health benefits, and educational assistance. We foster a diverse, inclusive workplace committed to making healthcare better for everyone. Join us and grow your career in an innovative, collaborative environment.