Claims Resolution Representative, Onsite Warwick, RI

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.
• 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.

“The deadline to submit applications for this posting is 10/20/2026” 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.