Gainwell Technologies मानव सेवाओं और सार्वजनिक स्वास्थ्य के पारिस्थितिकी तंत्र के लिए डिजिटल और क्लाउड-सक्षम समाधान विकसित करती है। कंपनी सभी 50 अमेरिकी राज्यों में ग्राहकों के साथ Medicaid Enterprise के आधुनिकीकरण, डेटा विश्लेषण, प्रदाता सेवाओं और फार्मेसी समाधानों जैसी स्वास्थ्य सेवा पहलों पर काम करती है। इसका कार्य प्रौद्योगिकी को सार्वजनिक स्वास्थ्य सेवाओं की आपूर्ति, स्वास्थ्य सेवा प्रशासन और स्वास्थ्य परिणामों तथा सामुदायिक कल्याण में सुधार के प्रयासों से जोड़ता है।
Medical Claims Research Analyst - California Hybrid
Research and resolve complex medical claims, provider inquiries, and healthcare operational issues for Gainwell Technologies. This California hybrid role also supports escalations, process improvements, and knowledge-sharing.
विवरण
- Investigate and resolve medical claims, provider inquiries, program questions, and operational issues ranging from routine to complex.
- Oversee claims research and related correspondence by reviewing inquiries, tracking cases, prioritizing work, and delivering accurate, timely resolutions.
- Work with providers, clients, leaders, and cross-functional teams to resolve issues, manage escalations, and advance program initiatives.
- Record complex resolutions, recognize recurring trends, and help ensure policies and procedures are applied consistently.
- Find opportunities to improve processes and recommend practical solutions that strengthen efficiency, service delivery, and customer outcomes.
- Contribute to knowledge-sharing and training efforts.
- Apply relevant federal, state, client, and organizational requirements.
आवश्यकताएँ
- At least three years of experience in healthcare operations, medical claims processing, claims research, provider support, customer service, business process outsourcing, or a related area.
- Background investigating and resolving medical claims, provider inquiries, and related healthcare operations issues.
- Strong analytical, research, problem-solving, organizational, and decision-making abilities.
- Capacity to manage competing priorities effectively.
- Excellent written, verbal, and interpersonal communication skills.
- Experience working with providers, clients, and cross-functional business partners.
- Working knowledge of provider operations, medical claims processing, customer support practices, and business systems for researching, tracking, and resolving inquiries.
- Experience evaluating business processes, spotting improvement opportunities, and developing practical solutions.
- California residency is required.
- Reliable high-speed internet access is required.
लाभ
- Flexible work options.
- Learning and career development opportunities.
- Generous, flexible vacation policy.
- 401(k) employer matching.
- Comprehensive health benefits.
- Educational assistance.
- Leadership and technical development academies.
- Remote work arrangement.