SummaryAs an
Experienced Claims Business Analyst at Gainwell, you 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.
Here are the details on this position.
Your role in our missionWhen joining Gainwell, you will:
- Analyze claims data to identify denial trends, operational bottlenecks, and opportunities to improve first-pass rates and reduce rework
- Perform in-depth investigation of complex claims issues, determining root causes across policy, data, user, or configuration factors
- Provide actionable recommendations and detailed documentation to support issue resolution, enhancements, and system improvements
- Collaborate with cross-functional teams (e.g., operations, IT, policy, finance) to reconcile claims outcomes and ensure data integrity
- Develop reporting, dashboards, and monitoring tools to provide insights and support leadership decision-making
What we're looking for- 9+ years of experience in claims business analysis, configuration, or healthcare operations, with strong experience in end-to-end claims workflows
- Advanced knowledge of healthcare claims processing, including coding (ICD-10, CPT, modifiers), billing, and adjudication rules
- Strong SQL skills and experience analyzing large datasets to identify trends, root causes, and performance improvements
- Proven ability to solve complex issues, translate technical findings into business insights, and work within client/vendor environments
- Strong communication, collaboration, and stakeholder engagement skills; experience in Medicaid or Medicare environments preferred
What you should expect in this role- Remote-based role within the United States
- Video cameras must be used during all interviews, as well as during the initial week of orientation
- This posting is intended for pipelining. This is a developing position therefore the job description is subject to change
- #LI-HC1
- #LI-Claims Business Analyst
- #LI-Healthcare Claims Coding
- #LI-ICD-10, CPT, modifiers
The pay range for this position is $86,800 - $124,000 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.
