Appeals Examiner - West Sacramento, CA (On-site)

$53,500 - $53,500/Yr

Gainwell Technologies - West Sacramento, CA

Full-time - Entry Level

West Sacramento, CA

Professional, Scientific, and Technical Services

About the position

The Appeals Examiner at Gainwell Technologies plays a crucial role in reviewing provider appeals and ensuring accurate documentation of appeal determinations. This position focuses on analyzing and researching appeal documentation to meet production goals while maintaining high-quality standards. The role is essential in supporting the health and well-being of vulnerable community members through effective claims management.

Responsibilities

• Review provider appeals using approved guidelines and document appeal determinations clearly and concisely.
• Analyze, research, and review appeal documentation to ensure all aspects of the appeal have been addressed properly and accurately while maintaining production goals and quality standards.
• Resubmit and adjust claims on approved appeals with the proper claim data correction and documentation.
• Maintain performance within defined quality and quantitative objectives.
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).

Requirements

• One (1) or more years of claims or appeals experience required.
• Experience working with insurance and/or medical terminology required.
• Highly proficient with exceptional level of accuracy required.
• Ability to research and verify claim payment issues.
• Knowledge of Microsoft products (Outlook, Word, Excel, and TEAMS).

Benefits

• Generous, flexible vacation policy
• 401(k) employer match
• Comprehensive health benefits
• Educational assistance
• Leadership and technical development academies