Muskingum County, Ohio, United States · Remote OK
$47k–$68k/yr
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 car…
Skills: Pharmacy Claims Adjudication, Medicaid Compliance, Claims Auditing, Team Leadership, Performance Metrics Monitoring
Perry County, Ohio, United States · Remote OK
$69k–$99k/yr
Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You’ll h…
Skills: Automation Testing, Gherkin, BDD, Cucumber, Selenium
Perry County, Ohio, United States · Remote Solely
$81k–$116k/yr
Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You’ll h…
Skills: Program Leadership, Strategic Planning, Stakeholder Management, Risk Management, Change Management
Perry County, Ohio, United States · Remote OK
Summary As Provider Enrollment Analyst - Remote US, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s mos…
Skills: Claims Processing, Medical Insurance Knowledge, Adjudication Decisions, Data Analysis, Multi-tasking
Muskingum County, Ohio, United States · Remote Solely
$36k–$51k/yr
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 car…
Skills: Pharmacy Operations, Prior Authorizations, Pharmacy Claims Processing, Customer Service, Problem Solving
Muskingum County, Ohio, United States · Remote Solely
$93k–$133k/yr
Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You’ll h…
Skills: Engineering Leadership, AWS Cloud Platforms, Cloud Native Architecture, Microservices, APIs
Perry County, Ohio, United States · Remote OK
$15/hr–$21/hr
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 opport…
Skills: Client Relationship Management, Data Analysis, Project Management, Customer Service, Report Building
Perry County, Ohio, United States · Remote Solely
$52k–$74k/yr
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 opport…
Skills: Verint Operations Manager, Platform Configuration, Business Analysis, Operations Analysis, Workforce Optimization
Muskingum County, Ohio, United States · On-site
Summary As Provider Enrollment Analyst - Remote US, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s mos…
Skills: Claims Processing, Adjudication, Medical Insurance Knowledge, Data Analysis, Multi-tasking
Muskingum County, Ohio, United States · Remote OK
$87k–$124k/yr
Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You’ll h…
Skills: SQL Development, Data Analysis, MMIS, Medicaid Pharmacy, X12 EDI Transactions
Perry County, Ohio, United States · Remote Solely
$85k–$121k/yr
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 car…
Skills: Clinical Training, Pharmacy Benefit Management, Medicaid Guidelines, Medicare Guidelines, Prior Authorization
Perry County, Ohio, United States · Remote OK
$117k–$167k/yr
Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You’ll h…
Skills: Product Management, Agile Methodology, Budgeting, Financial Management, Stakeholder Management
Muskingum County, Ohio, United States · Hybrid
$75k–$99k/yr
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 car…
Skills: Medical Review, Claims Processing, Business Analysis, Provider Support, Organizational Skills
Perry County, Ohio, United States · Remote OK
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 opport…
Skills: Claims Processing, Adjudication, Medical Insurance Knowledge, Data Analysis, Multi-tasking
Muskingum County, Ohio, United States · Remote OK
Summary As Provider Enrollment Analyst - Remote US, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s mos…
Skills: Claims Processing, Adjudication, Medical Insurance Knowledge, Data Analysis, Multi-tasking
Muskingum County, Ohio, United States · Remote OK
$81k–$116k/yr
Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You’ll h…
Skills: Project Management, Program Management, Operational Readiness, Stakeholder Communication, Risk Management
Muskingum County, Ohio, United States · Remote OK
Summary As Associate Business Process Services, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vu…
Skills: Claims Processing, Medical Adjudication, Insurance Principles, Data Analysis, Multi-tasking
Muskingum County, Ohio, United States · Remote OK
$87k–$124k/yr
Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You’ll h…
Skills: SQL Development, Data Analysis, MMIS, Medicaid Pharmacy, X12 EDI Transactions
Muskingum County, Ohio, United States · Remote Solely
$109k–$155k/yr
Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You’ll h…
Skills: Product Lifecycle Management, Strategic Roadmap Execution, Agile Methodology, Healthcare Technology, Pharmacy Benefit Management
Roseville, California, United States · Hybrid
$60k–$85k/yr
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 opport…
Skills: Business Process Re-engineering, Organizational Change Consulting, Process Design, Requirements Management, Project Management
Muskingum County, Ohio, United States • Remote OK
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Supervise claims audit operations within Pharmacy Benefit Management services to ensure accurate adjudication and Medicaid compliance. Lead a team in managing FWA Audit Services, including concurrent, desk, and field audits.
Requires 5+ years of experience in pharmacy operations or drug claims processing and 2+ years of leadership experience. A Nationally Certified Pharmacy Technician (CPhT) certification is required.
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.
Supervises claims audit operations within Pharmacy Benefit Management (PBM) services. Ensures accurate adjudication of pharmacy claims while maintaining compliance with Medicaid requirements and operational performance standards. The Claims Audit Supervisor will have oversight of all FWA Audit Services including Concurrent Claims Review, Desk Audit and Field Audit.
#LI-REMOTE
The pay range for this position is $47,300.00 - $67,600.00 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.
The people who build careers at Gainwell Technologies share one thing: they want their work to matter. Here, it does. We're the essential ingredient that makes Medicaid work. For more than 50 years, we've combined our sweeping scale and technology to turn complex policies into thriving programs. We act as the crucial connection bringing the U.S. healthcare ecosystem together, and we partner with state agencies to modernize public health. Our solutions translate complex member data into meaningful action. We streamline administration, connect vital systems, and drive efficiency. This gives providers more time to focus on delivering quality care to the people who need it most. When we bring Medicaid touchpoints to life, members thrive. From fighting fraud and recovering improper payments to speeding up verifications, every solution we deploy expands what's possible for the future of healthcare. Less burden, more mission. Gainwell.
Offices: United States, US
The people who build careers at Gainwell Technologies share one thing: they want their work to matter. Here, it does. We're the essential ingredient that makes Medicaid work. For more than 50 years, we've combined our sweeping scale and technology to turn complex policies into thriving programs. We act as the crucial connection bringing the U.S. healthcare ecosystem together, and we partner with state agencies to modernize public health. Our solutions translate complex member data into meaningful action. We streamline administration, connect vital systems, and drive efficiency. This gives providers more time to focus on delivering quality care to the people who need it most. When we bring Medicaid touchpoints to life, members thrive. From fighting fraud and recovering improper payments to speeding up verifications, every solution we deploy expands what's possible for the future of healthcare. Less burden, more mission. Gainwell.
Offices: United States, US
