Claims Analyst

6 hours ago

Columbus, Ohio, United States Gainwell Technologies LLC Full time
Job Summary

We are seeking a skilled Claims Analyst to join our team at Gainwell Technologies LLC. As a Claims Analyst, you will play a critical role in analyzing pre-payment pharmacy claims data, systems, and documents to identify potential claim overpayments and ensure claims are paid accurately.

Key Responsibilities
  • Analyze pharmacy claims pre-payment data and systems to ensure accurate payment determination.
  • Assist with special projects and provide training and guidance to team members.
  • Investigate and resolve claims issues, including overpayments and denials, using root cause analysis.
  • Create and maintain files according to organizational guidelines, ensuring accuracy and compliance.
  • Remain up-to-date on federal and state payment policies, as well as company policies and procedures.
  • Work collaboratively with various stakeholders, including pharmacies, members, and insurance representatives.
Requirements
  • Bachelor's or Master's degree in Business, Audit, Insurance, Healthcare, or related field preferred (or equivalent work experience).
  • At least 2 years of experience in claims analysis, claims processing, benefit configuration, or auditing in healthcare.
  • Experience in managed care, insurance, or pharmacy benefit management preferred.
  • Proficiency with pharmacy claims payment configuration systems, as well as MS Office, particularly Excel and Access.
  • Strong problem-solving capabilities and ability to perform root cause analysis to identify areas for process improvement.
  • Ability to recognize data discrepancies and irregularities in claim submissions.
What We Offer

We offer a competitive salary range of $47,000.00 - $67,200.00 per year, as well as a generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, 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 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.

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