Professional Claims Analyst - Remote US

Date: May 20, 2026 Location: Req ID: 34735 Work Mode: Virtual (Exception only) It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development. Summary Reporting to the Claims Manager, the Claims Analyst will be responsible for researching and analyzing paid and denied claims, POS system issues, and pricing discrepancies. The Claims Analyst will work closely with the Claims Manager to research pharmacy claims processing issues and inquiries including edit changes or new edit creation, respond to pharmacy inquiries, and develop an understanding of how the pharmacy claims processing system operates. In this role, you will evaluate claims trends, assess financial reporting practices, and identify opportunities to improve claims systems and operational processes. This position requires strong analytical expertise, sound judgment, and a thorough understanding of claims procedures and industry standards. Your role in our mission Assist the Claims Manager with day-to-day Claims Team operations, including training or mentoring less experienced staff, POS test case creation and validation, ad hoc smoke testing, weekly system deployments, post-implementation claims monitoring, and annual testing activities performed during and outside standard working hours. Assist with the development and periodic review of educational documents and workflows to ensure materials remain current and aligned with the objectives of assigned business units. Provide training and guidance to team members, offer feedback to management on claims and provider issues, and support updates to client business rules while acquiring knowledge of the claim adjudication system, member and provider contracts, and client claim payment policies and procedures. Resolve claims issues by researching claim situations and providing timely responses, while communicating with pharmacies, members, and insurance representatives to gather necessary information. Generate required client reporting, support audits by providing documentation and responding to inquiries, and assist with special projects and related team goals as determined by the Claims Manager. What we're looking for Bachelor’s degree in insurance, business administration, or a related field, or an equivalent combination of education and experience, with a minimum of three years of claims experience. Experience working with industry-standard claims processing systems and investigative tools, along with knowledge of claims processing procedures, documentation standards, administrative guidelines, and relevant legislative requirements. Ability to work under tight deadlines, manage multiple responsibilities, and work independently with minimal supervision in a fast-paced environment. Strong analytical, organizational, and problem-solving skills, with financial acumen, strong attention to detail, excellent time management, and the ability to quickly identify trends and discrepancies. Required understanding of and experience related to pharmacy claims payment configuration processes and systems, required pharmacy claims processing knowledge, Medicaid experience preferred, strong written and verbal communication skills, general computer proficiency including Microsoft Office and Excel, and Nationally Certified Pharmacy Technician certification. What you should expect in this role Remote work environment with collaboration across claims, compliance, and leadership teams throughout the U.S. High level of responsibility in reviewing sensitive financial and personal data while maintaining strict confidentiality. Opportunities to contribute to continuous improvement initiatives that enhance claims accuracy, reporting, and operational efficiency. Reliable high-speed internet connection required, with minimum download speed of 25 Mbps and upload speed of 10 Mbps. Access to Gainwell’s comprehensive benefits package in accordance with eligibility guidelines, including medical, dental, vision, 401(k), and other employee programs. The pay range for this position is $47,000.00 - $67,200.00 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 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), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.