Disability Case Examiner - Remote WI

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.

Summary

As a Disability Case Examiner, you will play a critical role in determining disability entitlement for children under the Social Security Disability Act and related regulations. This position involves extensive review and adjudication of medical and non-medical evidence, management of electronic and paper case files, and collaboration with internal and external stakeholders to ensure accurate and timely decisions. Your clinical expertise and experience with children’s populations will directly contribute to the health and well-being of the families we serve. 

Your role in our mission

• Review and evaluate medical and non-medical evidence to adjudicate disability entitlement under the Katie Beckett Disability Determination Program.
• Develop evidence by initiating consultative examinations, utilizing standardized forms, and collaborating with stakeholders for additional information.
• Perform critical analysis of child disability claims, determining functional limitations and domain impacts based on medical findings.
• Prepare thorough documentation of decisions, including standardized assessments and claimant notifications, in compliance with program regulations.
• Respond to appeals, preparing legal position papers, and collaborating with the Clinical Policy team for timely resolutions.
• Participate in structured meetings and training to stay updated on disability regulations, agency policies, and adjudicative procedures.

What we're looking for

• Comprehensive knowledge of the Katie Beckett Disability Determination Program and Social Security Disability regulations.
• Experience in disability claim adjudication, including understanding of medical terminology, disease processes, and functional limitations from impairments.
• Proven ability to manage diverse caseloads independently, prioritizing tasks to ensure timely and accurate adjudication.
• Strong analytical and problem-solving skills, with the ability to synthesize complex medical and non-medical data.
• Proficiency in desktop applications and systems such as BCPP mainframe, with strong keyboarding and document preparation skills.
• Exceptional written and verbal communication skills to prepare decisions and collaborate with claimants and stakeholders.

What you should expect in this role

• Work Environment: Fully remote position with standard working hours, Monday through Friday.
• Engage in meaningful work that supports families and ensures compliance with disability regulations.
• Collaborate with a team of professionals dedicated to delivering high-quality outcomes.
• Access to ongoing training and resources to stay updated on medical advancements, regulations, and best practices.
• Opportunities to develop expertise in a dynamic and impactful program that directly serves children with disabilities.

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LI-REMOTE

The pay range for this position is $54,300.00 - $77,500.00 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 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.