Hybrid First-Party Medical Claims Specialist

We are a company of driven, enthusiastic, and determined people. We celebrate achievement and success.We foster innovation, determination, and recognition. Because of that, our employees feel recognized and rewarded for the contributions they make daily. At GAINSCO, it is our people that set us apart. If you are looking for a place where you can make a difference, perceive how your work impacts the company, and be recognized for your efforts and passion, then GAINSCO is the company for you. Why JoinGAINSCO? GAINSCO’s work environment rewards engaged individuals who have a desire to contribute and succeed. That’s because our culture encourages individuals to grow their skills as they build their careers. Come join us and become a champion with GAINSCO. As a First Party Medical Claims Adjuster to process first-party medical claims across multiple states, ensuring accurate and timely payments in accordance with company guidelines. You’ll review medical bills and supporting documentation, respond to customer/provider inquiries, and help customers understand benefits and next steps throughout the medical claims process. What does a PIP/MED PAY CLAIMS REPRESENATIVE- MEDICAL MANAGEMENT do at GAINSCO? Review and process reimbursement requests under first-party medical coverage (PIP/Med Pay), applying fee schedules, policy terms, co-pays, and deductibles. Analyze claim documentation including medical bills/records, employment and wage info, and other supporting documents. Respond promptly to inquiries from injured parties, medical providers, and attorneys (written and verbal). Ensure PIP payment logs and requested claim/policy/payment information are provided within statutory timelines. Support customers throughout the medical claims process by explaining benefits, eligibility, required forms/procedures, and claim status updates. What is required? Education: High School Diploma or Equivalent. Licenses/ Certifications: Active licensure is not required at the time of application or hire. Candidates must be eligible to obtain a Texas or Florida Adjuster License. Upon hire, additional license(s) may be required. If that is the case, license(s) must be obtained. The required license must be obtained by passing the applicable state exam within two (2) attempts. All licenses must be maintained in accordance with state requirements. Professional Insurance and/or Claims Designations are a plus. Experience: Demonstrated success in customer service capacity. Comfortable working in a fast-paced, high-volume call center. Experience in an insurance call center or claims operation preferred. Experience with 1stParty Medical Claims is preferred. Experience with medical coding and/or medical billing a plus. Experience with Guidewire, Decision Point, and other claims systems preferred. Other skills and abilities: Strong verbal and written communication skills. Excellent attention to detail and organizational skills. Ability to manage multiple tasks and prioritize effectively. Analytical thinker with the ability to draw conclusions and make sound recommendations. Calm and professional demeanor when handling challenging situations. What else do you need to know? Hybrid Excellent benefits package: medical & dental, vision insurance, life insurance, short-term and long-term disability insurance. Parental Leave Policy 401K + Company Match PTO Plan + Paid Company determined Holidays. Applicants are required to be eligible to lawfully work in the U.S. immediately; employer will not sponsor applicants for U.S. work authorization (e.g. H-1B visa) for this opportunity All offers are contingent upon a successful background investigation (including employment, education, criminal and DMV verification- when applicable) and a pre-employment drug test with results satisfactory to GAINSCO. GAINSCO is an Equal Employment Opportunity Employer Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor. #J-18808-Ljbffr GAINSCO Auto Insurance