Appeals Examiner

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**:
As an Appeals Examiner at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges.

**Your role in our mission**:

- Review provider appeals using approved guidelines and documents appeal determinations clearly and concisely.
- Analyze, research and review appeal documentation to ensure all aspects of the appeal have been addressed properly and accurately while maintaining production goals and quality standards.
- Resubmit and adjust claims on approved appeals with the proper claim data correction and documentation.
- Maintain performance within defined quality and quantitative objectives.
- Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)

**What we're looking for**:

- One (1) or more years of claims or appeals experience required.
- Experience working with insurance and/or medical terminology required.
- Highly proficient with exceptional level of accuracy required.
- Ability to research and verify claim payment issues.
- Knowledge of Microsoft products (Outlook, Word, Excel and TEAMS)

**What you should expect in this role**:

- This is an On-site/Office environment at West Sacramento, CA
- Hours are 6:00 a.m. - 2:30 p.m.

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 committed to a diverse, equitable, and inclusive workplace. We are proud to be 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), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees._