Clinical Claims Analyst - Remote in US

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 have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.

Summary

Gainwell Technologies is seeking an experienced and talented Clinical Claims Analyst to manage various aspects of the claim selection process as well as to provide meaningful development and innovative analyses of healthcare data. In this role, you will be responsible for handling multiple clients and producing timely deliverables while utilizing statistical knowledge to deliver advanced methodologies to aid in recovery efforts and enhance claim selection.

Your role in our mission

• Claim Selection: Oversee claim selection processes and ensure data quality needs are met to deliver timely medical record requests. Design and maintain statistical and machine learning models to improve claim selection efficiency and accuracy.
• Data Analytics: Implementation of quality assurance checks to maintain standards for data integrity. Extract and compile various sources of information as well as large data sets to translate complex healthcare data issues and trends into opportunity analyses, action plans and manageable solutions.
• Client-Facing Analytics: Develop and deliver client-facing analytic solutions that provide actionable insights, demonstrate the value of payment integrity services, and enhance client satisfaction. Work closely with clients to understand their needs and tailor solutions to meet their objectives.
• Data Strategy: Develop and implement comprehensive data strategies to enhance predictive analytics, data mining, and machine learning models that drive payment accuracy and recovery initiatives.
• Stakeholder Engagement: Collaborate closely with cross-functional teams, including Operations, IT, Clinical, Compliance, and client management teams, to ensure that analytics initiatives meet both internal and external business needs.
• Reporting & Visualization: Create dashboards, reports, and data visualizations that provide clear and actionable insights to stakeholders and clients. Ensure that client-facing reports are tailored to communicate value effectively and drive client engagement.

What we're looking for

• Education: Bachelor’s degree in Statistics, Mathematics, Computer Science, or related field. Master’s degree preferred.
• Experience: Minimum 2 years of professional experience in data analytics, statistical analysis, or data management. Experience within the healthcare or payment integrity space is a strong plus.
• Technical Skills: Proficiency in data analytics tools (e.g., SQL, Python). Knowledge of healthcare data systems and payment integrity analytics is preferred.
• Communication: Exceptional communication skills, with the ability to translate complex data insights into actionable business recommendations for clients and executive leadership.
• Problem-Solving: Strong analytical and problem-solving skills, with a focus on identifying opportunities to enhance both internal operations and client outcomes.
• Collaboration: Proven ability to work collaboratively with cross-functional teams and manage multiple high-priority projects in a fast-paced environment.

What you should expect in this role

• This is a full-time permanent regular salaried (W-2) employee position.
  • Monday through Friday work schedule (40 hours per week).
• Upward career advancement is possible and encouraged.
• Health (medical, dental, vision) and paid time off benefits start on day 1 of employment.
• Company match 401K and other benefits available within months of starting.
• Computer for work company-provided.
• For all hybrid and remote positions employees' Broadband Internet connections, should have a minimum speed of 24MBS download and 8 MBS upload.  Greater speeds will of course provide better performance.
  • To Test your internet download and upload speed:
    • Go to Google.
    • Search for Internet Speed Test.  
• Video cameras must be used during all interviews, as well as during the initial week of orientation if hired.

This position is intended for pipelining. We will accept applications on an ongoing basis.

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#LI-REMOTE

The pay range for this position is $60,000 - $85,000 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.