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

We are seeking a talented individual for a Claims Examiner role, responsible for processing all casualty, worker’s compensation or estate functions involving several state Medicaid beneficiaries, commercial, or deceased Medicaid beneficiaries. This includes claims review and selection, management of case workflow, settlement and related functions.

Your Role in Our Mission

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  Interact professionally via verbal and written communication with attorneys, insurance adjusters, medical providers, court staff, recipients and family members and client.
• Effectively maintain and manage a variety of cases with documentation showing progression from creation to recovery.
• Provide timely and accurate information to move cases through the case management workflow.
• Confirm and validate third party liability and probate and beneficiary asset research.
• Prepare required correspondence, liens, claims and other related documents to progress the case to recovery.
• Negotiate and compromise claim/lien settlement amounts per contract guidelines.
• Process all claim/lien disputes and review claims with attorneys and other stakeholders.
• Conduct outgoing follow up on case status and payment.
• Perform advanced levels of document review to identify current case status, legal research, and case management.
• Prioritize case events and critical case payment/recovery issues, while meeting various internal and legal deadlines that are revenue impacting.
• Compile, analyze and make conclusions about case information and status from multiple sources.
• Handle high dollar and escalated cases for consistent follow up through settlement.
• Serve as a mentor and resource as needed for the team with new hire trainings, and serve as a subject matter expert for the contract and negotiation strategies.
• Assist the Operations Supervisor and Manager as needed with targeted projects and reporting as needed.

What We're Looking For

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  Ability to be careful and thorough about detail including cite-checking and proofreading skills.
• Ability to work proficiently with Microsoft Office, PowerPoint, Word, and Excel required.

• Experience in the medical, insurance, or legal field preferred; paralegal or legal assistant and/or experience in the insurance industry (casualty or health insurance) a plus

• Experience with analysis and case management of medical/legal cases preferred

• Experience with detailed written correspondence and verbal communication with customers and stakeholders required

What You Can Expect in This Role

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  This position requires working in an office in Conway, AR
• We provide all needed equipment and systems training
• Most benefits start on the first day of employment
• Monday through Friday work schedule
• Must be able to start within 2 weeks of receiving an offer of employment

#LI-NB1

#LI-ONSITE

The pay range for this position is $36,101.00 - $45,127.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our 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.