medical claims processor

Gainwell Technologies LLC

<div><div><div><div><div><p>Claims Specialist- Anchorage, AK (Hybrid)
</p></div></div></div></div><div><div><div><div><b>Date: </b>Jun 8, 2026
</div></div></div></div><div><div><div><div><b>Location:
</b>Any city, AK, US, 99999
</div></div></div></div><div><div><div><div><b>Req ID: </b>36193
</div></div></div></div><div><div><div><div><b>Work Mode: </b>Virtual (Exception only)
</div></div></div></div><div></div><div><div><div><div><div>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&rsquo;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.</div><div></div><div><div><div><div><b><br>
Summary</b></div>
</div><div><div>
As <b>Claims Specialist- Anchorage, AK (Hybrid)</b>, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve &mdash; a community&rsquo;s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare&rsquo;s biggest challenges. Here are the details on this position. HMS is hiring Claims Specialists to support our Alaska account. These positions processes moderately complex claims for our Alaska Medicaid client. They will make decisions on payment of medical claims using the existing policy and rules to ensure accurate and timely completion.</div></div></div><div></div><div><div><div><b><br>
Your role in our mission</b></div>
</div><div><ul><li>Review and research suspended medical claims and adjudicate them per DHS policy.</li>
<li>Refer claims to Utilization Review and Provider Services units.</li>
<li>Maintain necessary documentation.</li>
<li>Participate in meetings as necessary.</li>
<li>Participate in process improvement sessions.</li>
<li>Train as a back-up for other areas, such as document control, courier, and customer service desk.</li>
<li>Other duties as assigned</li>
</ul></div></div><div><div><div><b>What we're looking for</b></div>
</div><div><ul><li>Ability to work both independently and as part of a team.</li>
<li>Strong communication skills with the ability to communicate clearly and effectively in writing and verbally.</li>
<li>Ability to access and retrieve information using a PC.</li>
<li>Intermediate understanding of Microsoft Office products.</li>
<li>Organizational skills to balance and prioritize work, and analytical and problem-solving skills.</li>
</ul></div></div><div><div><div><b>What you should expect in this role</b></div>
</div><div><ul><li>Hybrid role with ability to work in the Anchorage, AK office preferred, with the possibility of working remotely from another state for the right candidate. The person will need to work Alaska Time hours.</li></ul><br>
<div></div>
<div>
#LI-LS2</div>
<div>
#LI-HYBRID</div></div></div></div><br>
<div></div>
<div>
The pay range for this position is $37,500.00 - $53,500.00 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&rsquo;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.</div><br>
<div></div>
<div>
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&rsquo;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.</div><br>
<div></div>
<div><i>
Gainwell Technologies </i><i>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. </i><i>Gainwell Technologies defines &ldquo;wages&rdquo; and &ldquo;wage rates&rdquo; to include &ldquo;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.</i></div></div></div></div></div></div><p></p>

Claims Specialist- Anchorage, AK (Hybrid)

CVS Health

<div><p>We&rsquo;re building a world of health around every individual &mdash; shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, you&rsquo;ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger &ndash; helping to simplify health care one person, one family and one community at a time.</p><p></p><p><b>
Position Summary</b></p><p>
Review and adjust SF (self-funded), FI (fully insured), Reinsurance, and/or RX claims; adjudicates complex, sensitive, and/or specialized claims in accordance with claim processing guidelines. Process provider refunds and returned checks. May handle customer service inquiries and problems.</p><ul><li>
Perform adjustments across all dollar amount level on customer service platforms by using technical and claims processing expertise.
</li><li>Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the claim adjudication process.</li><li>
Performs claim re-work calculations.</li><li>
Follow through completion of claim overpayments, underpayments, and any other irregularities.</li><li>
Process complex non-routine Provider Refunds and Returned Checks.</li><li>
Review and interpret medical contract language using provider contracts to confirm whether a claim is overpaid to allocate refund checks.
</li><li>Handle telephone and written inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals.</li><li>
Ensures all compliance requirements are satisfied and that all payments are made following company practices and procedures.</li><li>
Review and handle relevant correspondences assigned to the team that may result in adjustment to claims.</li><li>
May provide job shadowing to lesser experience staff.</li><li>
Utilize all resource materials to manage job responsibilities.</li></ul><p><b><br>
Required Qualifications</b></p><ul><li>
2+ years medical claim processing experience.</li><li>
Experience in a production environment.</li><li>
Demonstrated ability to handle multiple assignments competently, accurately, and efficiently.</li>
Effective communications, organizational, and interpersonal skills.<br>
<li>
</li></ul><p><br>
<b>Preferred Qualifications</b></p><ul><li>
DG system claims processing experience.</li><li>
Associate degree preferred.</li></ul><p><b><br>
Education</b></p><ul><li>
High School Diploma or GED.</li></ul><p></p><p><b>
Anticipated Weekly Hours</b></p>
40<p></p><p><b>
Time Type</b></p>
Full time<p></p><p><b>
Pay Range</b></p><p>
The typical pay range for this role is:</p><p></p>
$18.50 - $42.35<p></p><p>
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.</p><p><br>
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.</p><p></p><p><b>
Great benefits for great people</b></p><p></p><p>
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.</p><br>
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.<p><br>
Additional details about available benefits are provided during the application process and on Benefits Moments.</p><br>
We anticipate the application window for this opening will close on: 06/19/2026<p></p><p>
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</p></div>

Senior Claims Benefit Specialist

Wholistic Health and Wellness LLC

<p><b>Job Overview</b><br/>We are seeking a Medical Billing Specialist familiar with Waystar Clearing House to join our healthcare team. In this vital role, you will be responsible for managing the full cycle of medical billing processes, ensuring accurate and timely submission of claims, and optimizing revenue flow. Your expertise will support the financial health of our practice while providing exceptional service to patients and providers alike. This position offers an exciting opportunity to apply your medical coding knowledge and billing skills in a fast-paced, collaborative environment dedicated to quality care.</p><p>This position will not require much of your time and will allow you to apply your billing knowledge from the comfort of your home.</p><p>You must be familiar with Waystar!</p><p>Access to computer/laptop and printer is also recommended!</p><p>We need your expertise today! Call us now (614)429-8731</p><p><b>Responsibilities</b></p><ul><li>Prepare and submit insurance claims accurately using CPT (Current Procedural Terminology), ICD-9, and ICD-10 coding systems, ensuring compliance with payer guidelines, and ERA complianc.</li><li>Review medical records and documentation to verify the accuracy of diagnoses, procedures, and billing codes.</li><li>Follow up on unpaid or denied claims through effective communication with insurance companies and patients to facilitate prompt resolution.</li><li>Maintain detailed records of billing activities, payment histories, and correspondence within Electronic Medical Record (EMR) or Electronic Health Record (EHR) systems.</li><li>Collaborate with healthcare providers to clarify documentation requirements and ensure proper coding for DRG (Diagnosis-Related Group) assignments when applicable.</li><li>Monitor accounts receivable and perform collections for outstanding balances through professional outreach to patients or third-party payers.</li><li>Stay current with evolving healthcare regulations, coding updates, and billing best practices to ensure compliance and maximize reimbursement.</li></ul><p><b>Skills</b></p><ul><li>Strong understanding of medical terminology, medical records management, and healthcare documentation standards.</li><li>Proficiency in medical coding including CPT, ICD-9, ICD-10, DRG, and ICD coding systems.</li><li>Experience with medical billing processes, insurance claim submission, and medical collections.</li><li>Familiarity with EMR/EHR systems used for recording patient information and billing data.</li><li>Excellent attention to detail with the ability to analyze complex medical information accurately.</li><li>Effective communication skills for interacting with insurance companies, healthcare providers, and patients.</li><li>Knowledge of healthcare regulations related to billing practices and patient confidentiality. Join us as a Medical Billing Specialist to make a meaningful impact by ensuring smooth financial operations in a supportive healthcare environment!</li></ul><p>Pay: $50.00 - $100.00 per day</p><p>Benefits:</p><ul><li>Employee discount</li><li>Flexible schedule</li></ul><p>Work Location: Remote</p>

Medical Billing Specialist

Search 8214+ Medical claims processor jobs near you this June. New roles added regularly across leading industries. Apply today.

8214 medical claims processor jobs Near Me

Claims Specialist- Anchorage, AK (Hybrid)

Senior Claims Benefit Specialist

Senior Claims Benefit Specialist

Senior Claims Benefit Specialist

Senior Claims Benefit Specialist

Senior Claims Benefit Specialist

Medical Billing Specialist