Advisor Claims Business Analyst

Gainwell Technologies is a company that focuses on improving health and well-being through innovative technology solutions. The Advisor Claims Business Analyst role involves supporting claims workflow analysis, configuration support, and complex issue resolution within the MMIS ecosystem, leveraging expertise in Medicaid claims adjudication and data analysis.

Responsibilities:

• 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

Requirements:

• 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