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 managing all aspects of the casualty, worker’s compensation or estate casework involving several state Medicaid beneficiaries, commercial, or deceased Medicaid beneficiaries. This role requires autonomous decision-making including resolution of disputed items, negotiation of settlement in the best interest of our clients, and independently managing a case to an effective, timely resolution.
Your role in our mission
- Interact professionally in all contact with attorneys, insurance adjusters, medical providers, court staff, recipients and family members and client.
- Effectively maintain, evaluate, and manage a variety of cases with documentation showing progression from creation to recovery.
- Provide exemplary customer service with timely, relevant, and accurate information to stakeholders
- Confirm and validate third party liability, probate, and beneficiary asset research.
- Prepare required correspondence, liens, claims, probate filings and other related documents to progress the case to recovery.
- Negotiate and compromise claim/lien settlement amounts based on the facts of each case and per contract guidelines.
- Investigate all claim/lien disputes and utilize logic in determining the validity of said disputes.
- Analyze and independently control a wide variety of cases of varying scope and complexity within service level agreements
- Conduct outgoing follow up on case status and payment.
- Perform advanced levels of document review to identify current case status, legal research, case management, and escalation as needed.
- Prioritize and manage all case events and critical case payment/recovery issues, while meeting various internal and legal deadlines that are revenue impacting.
- Compile, analyze and make independent conclusions about case information and status from multiple sources
What we’re looking for
- Probate, legal document and/or asset research/investigation work experience preferred
- Knowledge of basic principles of case management with basic exposure to probate, LexisNexis, legal documents and Medicaid preferred
- Basic investigative and problem-solving skills to evaluate cases and determine actions required
- Strong written and oral communication skills to interact with external attorneys, family members and courts
- Ability to pay close attention to detail and legal deadlines to ensure quality and timeliness of case management
What you should expect in this role
- Must work Monday through Friday from 8 AM – 5 PM local time
- Must work in our Tucker, Georgia office at 100 Crescent Centre. Pky, Ste 1000
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The pay range for this position is $12.75 – $18.50 per hour, 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.