Claims Adjustment Analyst - HYBRID Wisconsin

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

The Claims Adjustment Analyst plays a key role in supporting the WI Claims and Adjustment teams by overseeing, creating, and prioritizing claim adjustments. This position requires strong analytical skills, attention to detail, and the ability to manage multiple tasks efficiently. The hybrid work model requires onsite presence at least 1 day per week, with flexibility for up to 3 days per week as needed. This role involves working closely with internal teams and state customers to ensure accurate claims processing and resolution.

Your role in our mission

• Perform data queries using SQL and data warehouse systems to analyze and determine the scope of each adjustment.
• Collaborate with internal teams and state customers to ensure proper data collection and accurate claims resolution.
• Maintain clear and consistent communication to provide leadership and stakeholders with status updates on adjustments.
• Identify, document, and present potential roadblocks or process concerns, offering solutions to improve efficiency.
• Read and interpret moderate to complex documents such as operating procedures, government guidelines, and healthcare policies.
• Manage multiple priorities, deadlines, and competing tasks while ensuring accuracy and compliance.

What we're looking for

• Experience in claims processing, data analysis, or adjustments within a healthcare or government setting.
• Strong ability to interpret policy guidelines, procedural documentation, and regulatory requirements.
• Proficiency in performing data queries and working with data warehouse systems.
• Ability to multi-task and prioritize workloads while maintaining a high level of accuracy.
• Excellent problem-solving skills with a proactive approach to process improvements.
• Strong written and verbal communication skills to present information and collaborate with various stakeholders.

What you should expect in this role

• A hybrid work environment, requiring onsite presence in Madison, WI at least 1 day per week, with the potential for up to 3 days as needed.
• Collaboration with internal teams, leadership, and external state customers to ensure accurate claims adjustments.
• Exposure to large-scale data analysis and process optimization within claims processing.
• A role that requires strong communication and organizational skills to maintain workflow efficiency.
• The opportunity to gain expertise in claims adjustments, regulatory compliance, and process automation.
• Access to training, development, and career growth opportunities within Gainwell Technologies.

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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 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.

Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.