Experienced Claims Business Analyst

Summary

As 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.

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
• The deadline to submit applications for this posting is July 9, 2026

Pay Range

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.

About the Role

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.”