Appeals Examiner - West Sacramento, CA (On-site)

Appeals Examiner - West Sacramento, CA (On-site)

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. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare's biggest challenges.

Your role in our mission:

• Review provider appeals using approved guidelines and documents appeal determinations clearly and concisely.
• Analyze, research and review appeal documentation to ensure all aspects of the appeal have been addressed properly and accurately while maintaining production goals and quality standards.
• Resubmit and adjust claims on approved appeals with the proper claim data correction and documentation.
• Maintain performance within defined quality and quantitative objectives.
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).

What we're looking for:

• 2 years or more in medical claims and appeals experience required.
• Experience working with medical insurance and/or medical terminology required.
• Highly proficient with exceptional level of accuracy required.
• Ability to research and verify claim payment issues.
• Knowledge of Microsoft products (Outlook, Word, Excel and TEAMS).

This is an On-site/Office environment at West Sacramento, CA Hours are 6:00 a.m. 2:30 p.m. The deadline to submit applications for this posting is August 10, 2026. 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.

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.