Claims Analyst - Remote US

Job Category: Healthcare

About Gainwell Technologies

At Gainwell, we 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. 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

Gainwell Technologies is looking for a highly analytical and detail-oriented Claims Analyst to join our remote team. This position supports prepayment claims analysis and report development for pharmacy claims under the guidance of the Claims Manager. You will work with internal stakeholders and external clients to ensure accurate claim submission and payment processes, while also contributing to continuous improvement through documentation, training, and system enhancements.

Your Role in Our Mission

As a Professional Claims Analyst, you will:

Responsibilities (What You’ll Do)

• Analyze pharmacy claims before payment to ensure accuracy and compliance.
• Assist in identifying and recovering overpayments or pricing errors.
• Prepare documentation, including manuals, policies, workflows, and educational materials.
• Develop and present recurring and data reports to internal and external stakeholders.
• Respond to claim inquiries from clients, pharmacies, and internal departments.
• Work with cross-functional teams to improve claims adjudication processes and system performance.

What We're Looking For

Requirements (What We’re Looking For)

• Education: Bachelor's or Master's degree in Business, Healthcare, Audit, Insurance, or related field, or equivalent experience.
• Experience: Minimum of 2 years in claims processing, analysis, auditing, or PBM operations; Medicaid experience preferred.
• Skills:
  • Strong working knowledge of pharmacy claims, adjudication systems, and benefit configuration.
  • Experience preparing documentation and training materials for internal and external audiences.
  • Proficient in Microsoft Outlook, Excel, Word, and PowerPoint.

Nice-to-Have

• National pharmacy technician certification and 2+ years of claims auditing experience.

What You Should Expect in This Role

• 100% remote, work-from-home position based in the U.S.
• Regular collaboration with internal teams and external clients.
• Must maintain reliable high-speed internet connection.
• Fast-paced, deadline-driven work environment.
• Opportunity to support continuous process improvement and contribute to special projects.

The pay range for this position is $47,000.00 - $67,200.00 per year; 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.