Expert Domain Lead - Provider+

Summary

As a Expert Domain Lead - Provider+ at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges.

About the role

The Expert Domain Lead - Provider+ plays a critical role in supporting technical execution for MMIS Medicaid Management Information Systems (MMIS) and/or the Medicaid Pharmacy environment. This role provides hands-on technical analysis, SQL development, data validation, integration support, and system troubleshooting across one or more functional domains, including Member, Provider, Claims (Medical, Dental, and/or Pharmacy), Utilization Management, Prior Authorization, Finance, and Plan/Care Management.

Responsibilities

• Develop and optimize complex SQL queries, views, and stored procedures to support analysis, reporting, validation, and defect resolution.
• Conduct deep data analysis and root-cause investigations to troubleshoot system and production issues.
• Extract, reconcile, and validate data across environments for solutioning, testing, and QA.
• Support performance tuning by analyzing queries, execution plans, batch jobs, and system throughput.
• Perform smoke testing and post-release validation to ensure data integrity and system stability.
• Partner with data conversion teams on migration planning, data loads, reconciliation, and validation.
• Ensure converted data is accurate, complete, and aligned with business and policy intent.
• Validate configuration syncs (e.g., Redgate) across environments.
• Analyze and reconcile interface outputs, extracts, reports, and feeds.
• Validate X12 EDI transactions (834, 837, 835, 820, 999/277) for structure, content, and outcomes.
• Manage reference data and standard code sets, investigating discrepancies.
• Translate business requirements into technical specifications and solution models in collaboration with Business Analysts.
• Utilize Data Element Dictionaries (DEDs) to understand structures and dependencies.
• Document data flows, integrations, and system relationships.
• Conduct feasibility analysis to identify constraints, impacts, and dependencies.
• Contribute technical insight in design workshops and present risks, impacts, or gaps to governance forums (ARB, CCB).
• Support SIT, UAT, parallel, and performance testing by validating data and system behavior.
• Assist with test data setup, environment readiness, validation scripts, and reconciliation.
• Analyze and resolve defects related to data, configuration, interfaces, and performance.
• Support deployments, cutover, hypercare, and post-production issue resolution.
• Act as a technical liaison across Business Analysts, developers, QA, configuration, conversion teams, and operations.
• Clearly communicate findings, risks, and resolutions.
• Collaborate on data mappings and validation with configuration teams.
• Mentor junior analysts on SQL, data standards, troubleshooting, and documentation.
• Lead sub-tracks within technical workstreams as needed.

Requirements

• Bachelor’s degree in Computer Science, Information Systems, Health Informatics, or a related field (or equivalent experience).
• 12+ years of experience as a Technical Analyst, Data Analyst, or Healthcare Systems Analyst.
• Advanced SQL skills, including complex joins, transformations, large dataset analysis, and stored procedures.
• Experience supporting MMIS, Medicaid, or Medicaid Pharmacy systems.
• Strong understanding of healthcare data and Medicaid domains (Member, Provider, Claims, Pharmacy, Finance, Care Management).
• Experience with data analysis, troubleshooting, and validating technical outputs.
• Strong analytical, documentation, and communication skills.

Qualifications

• Hands-on experience with QNXT or similar healthcare claims/encounter management platforms.
• Familiarity with Data Element Dictionaries (DEDs), interface specifications, and integration design.
• Experience validating X12 EDI transactions and healthcare interfaces.
• Experience supporting data conversion, reconciliation, and parallel testing.
• Exposure to cloud platforms (AWS, Azure, or Google Cloud).

Skills

• Advanced SQL skills, including complex joins, transformations, large dataset analysis, and stored procedures.
• Experience supporting MMIS, Medicaid, or Medicaid Pharmacy systems.
• Strong understanding of healthcare data and Medicaid domains (Member, Provider, Claims, Pharmacy, Finance, Care Management).
• Experience with data analysis, troubleshooting, and validating technical outputs.
• Strong analytical, documentation, and communication skills.

Benefits

Gainwell Technologies offers a fully remote option from continental US locations only. Video cameras must be used during all interviews, as well as during the initial week of orientation. The pay range for this position is $108,500 - $155,000 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. 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.

Pay

The pay range for this position is $108,500 - $155,000 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.