About this role
About the Role Gainwell is seeking an Appeals Examiner to review provider appeals, analyze documentation, and ensure accurate determinations while meeting production and quality standards. This role supports improving the health and well-being of members by applying approved guidelines and maintaining HIPAA confidentiality.
What You'll Do
- Review provider appeals using approved guidelines and document appeal determinations clearly and concisely.
- Analyze, research, and review appeal documentation to ensure all aspects are addressed properly and accurately while maintaining production goals and quality standards.
- Resubmit and adjust claims on approved appeals with proper data correction and documentation.
- Maintain performance within defined quality and quantitative objectives.
- Maintain confidentiality and comply with HIPAA.
What We're Looking For
- Total of two years or more in medical claims and appeals experience required.
- Experience working with medical 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).
Compensation & Benefits
- Salary range: $37,500 - $53,500 per year.
- All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance.