Experienced Claims Business Analyst

Gainwell Technologies is an industry leader in healthcare solutions, and they are seeking an Experienced Claims Business Analyst. In this role, you will support end-to-end claims workflow analysis and issue resolution, leveraging expertise in Medicaid claims adjudication and data analysis to drive improvements in claims operations.

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