Medicaid Sr. Caseworker (Hybrid - Raleigh, NC)

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

HMS works to make the healthcare system better for everyone. We identify and prevent fraud, waste, and abuse so individuals can access the care they need—now and in the future. Through innovative technology and powerful data analytics, we help government and commercial payers reduce costs, improve quality, and meet regulatory requirements. We also empower consumers to take a more active role in their health. Each year, we save our clients billions of dollars while supporting healthier communities.
At HMS, you will have the opportunity to develop new skills, grow your career in a dynamic industry, and make a meaningful difference in the lives of others.
We are seeking a detail-oriented and motivated Case Management Assistant (Onsite). This role is responsible for verifying, documenting, and coordinating information required to process applications and case management assignments. Responsibilities include confirming third-party liability, validating documentation, coordinating with employers, and providing high-quality customer service while ensuring accurate data entry, timely processing, and compliance with program requirements.

Your role in our mission

• Provide enrollment support and HIPP/Premium Assistance program information to Medicaid-eligible individuals and their families via phone.
• Verify, document, and investigate healthcare coverage for Medicaid recipients and their dependents.
• Identify members who may qualify for the HIPP/Premium Assistance program.
• Complete periodic and ad-hoc reports as required.
• Handle high-volume customer service calls, including inquiries about the HIPP/Premium Assistance program.
• Perform accurate and timely data entry.
• Obtain and/or verify all documentation required for eligibility and enrollment into the HIPP/Premium Assistance program.
• Maintain active cases during open enrollment and premium review periods to support revenue and program growth.
• Independently manage a variety of cases of differing complexity within established service level agreements.
• Conduct outgoing follow-up calls regarding case status, payments, or outstanding requirements.
• Perform advanced document review, case status identification, basic legal research, and escalate issues when necessary.
• Prioritize and manage all case events and critical payment/recovery tasks while meeting internal and regulatory deadlines.
• Interact professionally with attorneys, insurance adjusters, medical providers, court staff, recipients, family members, and internal clients.

What we're looking for

• 2+ years of relevant professional experience in subrogation, claims, or case management.
• Proficiency in Microsoft Word and Excel; basic knowledge of Microsoft Access is preferred.
• Experience in a legal or insurance office setting (Estate recovery or casualty preferred).
• Familiarity with Medicaid and/or Medicare programs is preferred

What you should expect in this role

• Hybrid work arrangement based in the Raleigh, Norrth Carolina office — onsite 2 days per week.
• Schedule: Monday–Friday, 8:00 AM – 5:00 PM.
• Video cameras are required during all interviews and throughout the first week of orientation.
• To work effectively as a teleworker or hybrid employee, you must have broadband internet with a minimum speed of 24 Mbps download and 8 Mbps upload (higher speeds recommended for optimal performance).

This posting is intended for pipelining. We will accept applications on an ongoing basis.

#LI-HYBRID #LI-JA1 #LI-CM1

The pay range for this position is $35,500.00 - $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.