Business Analyst

Gainwell uses technology to help clients improve the health and well-being of the members they serve. The Professional Business Analyst - Claims supports moderately complex projects by analyzing business needs, documenting requirements, participating in client discussions, and serving as a liaison between business and technical teams. The role also evaluates business issues, recommends solutions, and helps ensure technology changes align with client objectives.

Responsibilities:

• Assist in planning and designing business processes; help formulate recommendations that improve and support client business activities
• Analyze and document client business requirements and processes for moderately complex projects, and communicate those requirements clearly to technical personnel
• Participate in client meetings and facilitate moderately complex discussions to gather and document requirements and explore potential solutions
• Develop and modify systems requirements documentation to meet client needs; independently document requirements for simple projects or assigned subsystems
• Participate in technical reviews and inspections to verify that the intent of a change is carried through each phase of the project
• Use business solutions and analytical tools, such as Excel and basic relational database concepts, to evaluate information and support recommendations

Requirements:

• Medical claim adjudication knowledge and experience across multiple payers
• Experience with creating functional requirements documentation like DSDs (Design Specification Document) and BRDs (Business Requirements Document)
• Configuration of claims related business rules based on policy, business, and technical requirements
• 2 to 5 years of experience in a Business Analyst, systems analyst, or related role working with information technology and functional business groups
• A bachelor's degree in a technical or business discipline, or equivalent combination of education and experience
• Intermediate knowledge of requirements determination, documentation, analysis, evaluation/validation, traceability, prioritization, and requirements change management
• Ability to decompose high-level information into detailed low-level information, and distinguish requests from needs and requirements from solutions
• Functional analytical, problem-solving, presentation, personal computer, and business solutions software skills
• Effective verbal and written communication skills, with the ability to build relationships, work collaboratively, and manage difficult client interactions professionally
• Experience working with business processes and process improvement concepts
• Fully remote options from continental US locations only
• Experience with project and change management tools such as ALM, iTrace, or rTrace preferred
• Experience developing structured user manuals, training documentation, business rules models, or requirements traceability preferred
• Health Care, Health Insurance, Medicaid, MMIS, or claims-processing experience preferred, including familiarity with Institutional and Professional/Physician claim forms and related concepts such as Prior Authorization, Member, Provider, Long-Term Care, Inpatient, and Outpatient processing