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Claims Resolution Representative Hybrid Warwick, RI
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$31k–$44k/yr
Full-time
Flexible vacation policy, 401(k) employer match, Health benefits, Educational assistance, Leadership development, Technical development
Posted 9d ago
Apply by Aug 25
~40 hrs/week
Responsibilities
The representative will perform routine healthcare claims processing tasks, including prior authorizations, manual pricing, and third-party liability management. They are also responsible for researching and resolving customer inquiries while ensuring compliance with state and federal regulations.
Requirements
Candidates typically require 3 to 5 years of general experience or an equivalent combination of education and experience. Proficiency in Microsoft Office and the ability to interpret healthcare laws and regulations are essential.
Full job description
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
Perform routine but moderately complex tasks that are related to healthcare policy and claims processing including prior authorizations, third-party liability, and manual pricing. Apply knowledge of established procedures and policy to research and resolve customer questions or management requests utilizing policy manuals. Ensure that claims are processed according to state and federal regulations while meeting contractual obligations. Resolve most problems and escalates only the most complex issues to immediate supervisor. Examples of work performed may include preparing correspondence, report preparation, verifying data, researching, completing forms collections and data entry. Performs other duties as assigned. Involved in the training of new employees and may take the lead in areas of expertise.
Your role in our mission
Resolve suspended medical claims utilizing Medical Assistance Policy.
Entry and/or approval of medical Prior Authorizations.
Entry and maintenance of third-party insurance information to facilitate coordination of benefits and benefit recovery. Identification of accident-related claims.
Identification of accident-related claims
Research, entry, and maintenance of HCPC and CPT codes; Entry of nursing home, hospital, federally qualified health centers and ambulatory surgical center rates.
What we're looking for
Typically requires 3 – 5 years general experience, or equivalent combination of experience and college-level education.
Healthcare, insurance, or third-party billing experience helpful
Self-motivated with excellent time management and organizational skills; ability to work independently.
Experience with Microsoft Outlook, Word, and proficiency with Excel
Ability to interpret healthcare policy, laws, and regulations.
What you should expect in this role
On-site environment located in Warwick, RI. Hybrid possible after training.
#LI-Hybrid
#LI-LS2
The deadline to submit applications for this posting is 08/17/2026. LS
The pay range for this position is $30,500.00 - $43,500.00 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.
Based on 1974 listings with disclosed salaries, most healthcare jobs in Ohio pay between $60k–$150k per year. Individual offers vary with seniority, company size, and specialization.
How many Healthcare jobs are open in Ohio right now?
There are currently 20,871 open healthcare positions in Ohio listed on Clera. New openings are added daily as companies post roles.
Which companies are hiring for Healthcare roles in Ohio?
Companies currently hiring include Bon Secours Mercy Health, CVS Health, University Hospitals, TriHealth, Cleveland Clinic, among others. Browse the listings above to see every active employer.
Are there remote or hybrid Healthcare jobs in Ohio?
Yes — 1716 of the 20871 open healthcare positions offer remote or hybrid work (787 remote, 929 hybrid).
How do I apply for Healthcare jobs in Ohio?
Each listing links directly to the employer's application page. Apply early — fresh listings get the most recruiter attention in the first two weeks.