Pharmacy Lead Claims Analyst – Remote US

Job Description

Job Ttitle: Pharmacy Lead Claims Analyst – Remote US

Company: Gainwell Technologies


Description: 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.SummaryReporting to the Claims Manager, the Lead Claims Analyst will be responsible for researching and analyzing paid and denied claims, POS system issues, and pricing discrepancies. The Lead Claims Analyst will work closely with the Claims Manager to research pharmacy claims processing issues and inquiries including edit changes or new edit creation, respond to pharmacy inquiries, and develop an understanding of how the pharmacy claims processing system operates.Your role in our mission

• Assist Claims manager with the day-to-day operations of the Claims Team, including training and/or mentoring less experienced staff, PPAC inquiries, POS test case creation and validation, post implementation claims monitoring
• Assist with the development and periodic review of educational documents and workflows to ensure that materials are up-to-date and meet the objectives of the assigned business units.
• Provide training and guidance to team members by providing feedback to management on claims, provider issues, and updating client business rules.
• Acquire knowledge of the claim adjudication system, member and provider contracts, and client claim payment policies and procedures.
• Resolve claims issues by researching claim situations and providing timely responses.

What we’re looking for

• Bachelor’s degree in business, audit, healthcare, or related field preferred or equivalent work experience.
• 2 years of experience in a claim analytical, claims processing, benefit configuration or QA/auditing role in healthcare required.
• Required understanding of and experience related to pharmacy claims payment configuration process/systems.
• Required pharmacy claims processing knowledge.
• Nationally Certified Pharmacy Technician

What you should expect in this roleThis is a 100% remote position.#LI-REMOTE #LI-JT1The pay range for this position is $58,800.00 – $84,000.00 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 , 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 and visit our 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.

Salary: $58800 – 84000 per year

Location: Ohio

Date: Thu, 17 Jul 2025 22:57:18 GMT


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