Medical Claims Research Analyst

Gainwell Technologies

. Research, analyze, and resolve routine to complex medical claims, provider inquiries, program questions, and operational issues .

Posted 10/4/2026full-timeCalifornia • United StatesMid-LevelSenior💰 $70,000 - $75,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in healthcare operations and medical claims processing, with a strong focus on problem-solving, process improvement, and effective communication. Capable of managing multiple priorities while collaborating with providers and cross-functional teams to enhance service delivery and customer outcomes.

Highest-signal resume keywords

Healthcare Operations ExperienceMedical Claims ProcessingAnalytical SkillsProblem-Solving SkillsInterpersonal Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Claims ResearchProvider SupportBusiness Process ImprovementOperational Issue ResolutionDocumentation of Issue Resolution

Soft Skills

Organizational SkillsDecision-Making SkillsCollaboration SkillsTime Management

Tools & Technologies

Business Systems for Claims ResearchCustomer Support Practices

Industry Keywords

Federal RequirementsState RequirementsClient RequirementsOperational PoliciesService Delivery

About the role

Key responsibilities & impact

Research, analyze, and resolve routine to complex medical claims, provider inquiries, program questions, and operational issues
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
Document complex issue resolution, identify trends, and support 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
Interpret and apply applicable federal, state, client, and organizational requirements

Requirements

What you’ll need

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
Experience researching and resolving medical claims, provider inquiries, and related healthcare operational issues
Strong analytical, research, problem-solving, organizational, and decision-making skills
Ability to manage multiple priorities
Excellent written, verbal, and interpersonal communication skills
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
Must reside in California
Reliable high-speed internet connectivity is required

Benefits

Comp & perks

Work flexibility
Learning and career development
Generous, flexible vacation policy
401(k) employer match
Comprehensive health benefits
Educational assistance
Leadership and technical development academies
Remote work arrangement