Experienced Claims Business Analyst

<span class="jobdescription"><p><span style="font-size:12.0pt;font-family:arial, helvetica, sans-serif">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. </span></p> <p> </p><div><div style="padding:10.0px 0.0px;border:1.0px solid transparent"><div style="font-size:18.0px;word-wrap:break-word"><h2 style="font-size:1.0em;margin:0.0px"><b>Summary</b></h2> </div><div><p><span style="font-family:arial, helvetica, sans-serif;font-size:12.0pt">As an <strong>Experienced Claims Business Analyst</strong> at Gainwell, ou will support end-to-end claims workflow analysis, configuration support, and complex issue resolution within the MMIS ecosystem. This role provides advanced (L2) support for claims operations by leveraging deep expertise in Medicaid claims adjudication, data analysis, and cross-functional collaboration. You will drive root-cause analysis, identify trends, and recommend solutions that improve first-pass rates, reduce denials, and support client and organizational objectives.</span></p> <p><span style="font-family:arial, helvetica, sans-serif;font-size:12.0pt">Here are the details on this position.</span></p></div></div><div style="padding:10.0px 0.0px;border:1.0px solid transparent"><div style="font-size:18.0px;word-wrap:break-word"><h2 style="font-size:1.0em;margin:0.0px"><b>Your role in our mission</b></h2> </div><div><p><span style="font-family:arial, helvetica, sans-serif;font-size:12.0pt">When joining Gainwell, you will:</span></p> <ul style="list-style-type:disc" type="disc"> <li style="font-family:arial, helvetica, sans-serif;font-size:12.0pt"><span style="font-family:arial, helvetica, sans-serif;font-size:12.0pt">Analyze claims data to identify denial trends, operational bottlenecks, and opportunities to improve first-pass rates and reduce rework</span></li> <li style="font-family:arial, helvetica, sans-serif;font-size:12.0pt"><span style="font-family:arial, helvetica, sans-serif;font-size:12.0pt">Perform in-depth investigation of complex claims issues, determining root causes across policy, data, user, or configuration factors</span></li> <li style="font-family:arial, helvetica, sans-serif;font-size:12.0pt"><span style="font-family:arial, helvetica, sans-serif;font-size:12.0pt">Provide actionable recommendations and detailed documentation to support issue resolution, enhancements, and system improvements</span></li> <li style="font-family:arial, helvetica, sans-serif;font-size:12.0pt"><span style="font-family:arial, helvetica, sans-serif;font-size:12.0pt">Collaborate with cross-functional teams (e.g., operations, IT, policy, finance) to reconcile claims outcomes and ensure data integrity</span></li> <li style="font-family:arial, helvetica, sans-serif;font-size:12.0pt"><span style="font-family:arial, helvetica, sans-serif;font-size:12.0pt">Develop reporting, dashboards, and monitoring tools to provide insights and support leadership decision-making</span></li> </ul></div></div><div style="padding:10.0px 0.0px;border:1.0px solid transparent"><div style="font-size:18.0px;word-wrap:break-word"><h2 style="font-size:1.0em;margin:0.0px"><b>What we're looking for</b></h2> </div><div><ul style="list-style-type:disc" type="disc"> <li style="font-family:arial, helvetica, sans-serif;font-size:12.0pt"><span style="font-family:arial, helvetica, sans-serif;font-size:12.0pt">9+ years of experience in claims business analysis, configuration, or healthcare operations, with strong experience in end-to-end claims workflows</span></li> <li style="font-family:arial, helvetica, sans-serif;font-size:12.0pt"><span style="font-family:arial, helvetica, sans-serif;font-size:12.0pt">Advanced knowledge of healthcare claims processing, including coding (ICD-10, CPT, modifiers), billing, and adjudication rules</span></li> <li style="font-family:arial, helvetica, sans-serif;font-size:12.0pt"><span style="font-family:arial, helvetica, sans-serif;font-size:12.0pt">Strong SQL skills and experience analyzing large datasets to identify trends, root causes, and performance improvements</span></li> <li style="font-family:arial, helvetica, sans-serif;font-size:12.0pt"><span style="font-family:arial, helvetica, sans-serif;font-size:12.0pt">Proven ability to solve complex issues, translate technical findings into business insights, and work within client/vendor environments</span></li> <li style="font-family:arial, helvetica, sans-serif;font-size:12.0pt"><span style="font-family:arial, helvetica, sans-serif;font-size:12.0pt">Strong communication, collaboration, and stakeholder engagement skills; experience in Medicaid or Medicare environments preferred</span></li> </ul></div></div><div style="padding:10.0px 0.0px;border:1.0px solid transparent"><div style="font-size:18.0px;word-wrap:break-word"><h2 style="font-size:1.0em;margin:0.0px"><b>What you should expect in this role</b></h2> </div><div><ul> <li style="font-family:arial, helvetica, sans-serif;font-size:12.0pt"><span style="font-family:arial, helvetica, sans-serif;font-size:12.0pt">Remote-based role within the United States</span></li> <li style="font-family:arial, helvetica, sans-serif;font-size:12.0pt"><span style="font-family:arial, helvetica, sans-serif;font-size:12.0pt">Video cameras must be used during all interviews, as well as during the initial week of orientation</span></li> <li style="font-size:12.0pt"><span style="font-family:arial, helvetica, sans-serif;font-size:12.0pt"><strong>The deadline to submit applications for this posting is July 9, 2026</strong></span></li> </ul></div></div></div><p> </p> <p><span style="font-size:12.0pt;font-family:arial, helvetica, sans-serif">The pay range for this position is $86,800.00 - $124,000.00 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 <span style="color:#cb1ac6"><a style="color:#cb1ac6" href="https://jobs.gainwelltechnologies.com/content/benefits/?locale=en_US">401(k) employer match, comprehensive health benefits</a></span>, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.</span></p> <p><span style="font-size:12.0pt"><span style="font-family:Calibri"> </span></span></p> <p><span style="font-size:12.0pt"><span style="font-family:Arial">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 <span style="color:#cb1ac6"><a style="color:#cb1ac6" href="https://www.gainwelltechnologies.com/">company website</a></span> and visit our <span style="color:#cb1ac6"><a style="color:#cb1ac6" href="https://jobs.gainwelltechnologies.com/">Careers site</a></span> for all available job role openings.</span></span></p> <p><span style="font-size:11.0pt"><span style="font-family:Calibri"> </span></span></p> <p><span style="font-size:12.0px;font-family:arial, helvetica, sans-serif"><em style="font-style:italic">Gainwell Technologies <span style="color:#32363a">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. <span style="font-size:12.0px;font-family:arial, helvetica, sans-serif">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.</span></span></em></span></p> </span>