Medical Claims Specialist - Hamilton, NJ

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 Medical Claims Specialist - Hamilton, NJ , 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.

Here are the details on this position.

Your role in our mission

Help create the power in Gainwell’s processes as we develop purpose-built technologies and solutions that yield better health and human services outcomes.

• Resolves pending claims based on Medicaid rules and regulations established for final processing.
• Processes claim adjustments through Reversal / Replacement requests submitted by providers.
• Price claims manually as required by Medicaid rules and system limitations as defined by policy and departmental procedures.
• Meets established production requirements consistently.
• Maintains an accuracy rate of 98% or better.

What we're looking for

• Basic knowledge of Microsoft Office Outlook, Word, and Excel
• Good working knowledge of medical claims systems
• Knowledge of CPT / HCPCS and ICD9 coding procedures and guidelines
• Mathematical background a plus
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)

What you should expect in this role

This is an on-site position.

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The pay range for this position is salaryMin - salaryMid 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.