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Summary

We are seeking a talented individual for a Senior Assistant Claims Examiner who is responsible for processing all who is responsible for processing all probate and estate functions involving several state Medicaid beneficiaries or deceased Medicaid beneficiaries. This includes intake, maintenance, claims review and selection, asset investigation, court filings and deadline management, settlement and other related functions to the case. Medicaid beneficiaries. This includes claims review and selection, management of case workflow, settlement and related functions.

Your role in our mission:

Interact professionally (i.e. on incoming and outgoing calls) with attorneys, insurance adjusters, medical providers, court staff, recipients and family members and client.
Effectively maintain and manage a variety of cases with current and accurate notes from creation to recovery
Maintain a daily system of providing timely and accurate information required to move cases through the case management workflow.
Daily telephone contact with counterparties, including attorneys, adjusters and healthcare providers
Independently work cases of high dollar value up to and through settlement
Confirm and validate third party liability and, probate and beneficiary asset research.
Prepare required correspondence, liens, claims and other related documents to progress the case to recovery.
Negotiate and compromise claim/lien settlement amounts per contract guidelines.
Process all claim/lien disputes and review claims with attorneys and other stakeholders.
Conduct outgoing follow up on case status and payment.
Perform basic and advanced levels of document review to identify current case status, legal research, and case management and ensure case progress through workflow
Prioritize case events and critical case payment/recovery issues, while meeting, various internal and legal deadlines that are revenue impacting.
Compile, analyze and make conclusions about case information and status from multiple sources.
May serve as an escalation point for assistant claims examiner

What we're looking for

Responsible for processing all estate functions involving several deceased Medicaid beneficiaries.
This includes intake, maintenance, claims review and selection, management, settlement and related functions to the case.
Maintain a daily system of providing timely and accurate information required to move cases through the verification and case management pipeline.
Compile, analyze and make conclusions about information from multiple sources.
Give special attention to the timely processing of events, various legal deadlines, and critical accounting/finance issues.
Perform basic and advanced levels of document review, legal research, and case management.
Assist with supervising all activities associated with a full agenda of an operating department's day-to-day functions.
Provides training, coaching, and mentoring to staff as appropriate.
Acts as an escalation point for team.
Provides reports and updates to management as assigned or requested.
Assist with managing operational workflows; meet internal and external SLA's (Service Level Agreements).
Supports and administers various departmental and corporate policies consistent with the company's core values and philosophies.
Assist with developing and maintaining work procedures, schedules, and workflow.
Recommends process improvements.
Organizes and leads team meetings.

What should you expect in this role

Hybrid (Onsite for training, then 1-2 days a week onsite)
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The pay range for this position is $20.00 - $25.00 an 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.