Medical Claims Research Analyst - Remote California

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

The Medical Claims Research Analyst supports providers, clients, and internal stakeholders through comprehensive medical claims research, issue resolution, correspondence, and operational support.

This role investigates routine to complex medical claims and provider inquiries, develops accurate and timely responses, and collaborates across multiple functional areas to resolve issues. The ideal candidate demonstrates strong analytical, research, communication, and problem-solving skills with the ability to work independently while ensuring accurate and compliant outcomes.

Your role in our mission

• Research, analyze, and resolve routine to complex medical claims, provider inquiries, program questions, and operational issues using established policies, procedures, and available resources.
• Manage claims research and correspondence by reviewing inquiries, monitoring case progress, prioritizing assignments, and ensuring accurate and timely resolution.
• Collaborate with providers, clients, leadership, and cross-functional teams to resolve issues, facilitate escalations, and support program initiatives.
• Contribute to shared knowledge resources by documenting complex issue resolution, identifying trends, and supporting consistent application of policies and procedures.
• Identify process improvement opportunities and recommend solutions that improve efficiency, service delivery, and customer outcomes.
• Support knowledge-sharing and training activities while interpreting and applying applicable federal, state, client, and organizational requirements.

What we're looking for

• Three or more years of experience in healthcare operations, medical claims processing, claims research, provider support, customer service, business process outsourcing, or a related field; Medi-Cal or Medicaid experience preferred.
• Experience researching and resolving medical claims, provider inquiries, and related healthcare operational issues.
• Strong analytical, research, problem-solving, organizational, and decision-making skills with the ability to manage multiple priorities.
• Excellent written, verbal, and interpersonal communication skills with experience collaborating with providers, clients, and cross-functional business partners.
• Working knowledge of provider operations, medical claims processing, customer support practices, and business systems used to research, track, and resolve inquiries.
• Experience working with business processes, identifying improvement opportunities, and developing practical solutions that improve operational effectiveness.

What you should expect in this role

• Remote position; must reside in California.
• Occasional onsite attendance in West Sacramento, California may be required for meetings, training, special projects, or other business needs.
• Reliable high-speed internet connectivity is required.
• Opportunity to support critical provider and client operations while contributing to continuous improvement initiatives.

This is a pipeline requisition designed to build a pool of qualified candidates for current and future opportunities as positions become available.

#LI-REMOTE

#LI-MA1

The pay range for this position is $70,000 - $75,000 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 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.