Gainwell Technologies

Analyst

• support provider enrollment and provider revalidation operations by ensuring the accuracy, quality, and compliance of provider enrollment transactions, documentation, and operational processes.
• Conduct quality reviews and audits of provider enrollment applications, provider revalidations, maintenance requests, renewals, and supporting documentation to ensure accuracy, completeness, and compliance with CMS, ACA, state, and federal guidelines.
• Monitor operational quality standards, productivity trends, documentation accuracy, and workflow compliance while identifying deficiencies, root causes, and opportunities for process improvement.
• Review and evaluate provider-related communications, case documentation, and enrollment activities to ensure adherence to internal policies, operational procedures, and client service expectations.
• Prepare reports, analyze quality findings, communicate audit results, and collaborate with leadership to recommend corrective actions, training opportunities, and procedural enhancements.
• Support calibration sessions, quality initiatives, audits, training activities, and continuous improvement efforts while maintaining confidentiality and compliance with HIPAA and company security standards.

Provider Enrollment Quality Analyst

• Support provider enrollment and provider revalidation operations for Medicaid healthcare programs
• Review, process, and verify provider enrollment and provider revalidation applications for accuracy, completeness, and compliance with Medicaid and CMS guidelines
• Research, analyze, and resolve provider enrollment discrepancies by working with providers, internal departments, and external stakeholders while identifying potential fraud or inconsistent information
• Maintain accurate provider records within enrollment systems and perform quality audits, validation checks, and reporting activities to support operational accuracy and program integrity
• Interpret policies, procedures, and workflow requirements while supporting process improvements and updated standard operating procedures within a high-volume operational environment
• Handle confidential provider and healthcare information in accordance with HIPAA, company security standards, and regulatory compliance requirements while meeting productivity and quality expectations

Provider Enrollment Analyst

Account Manager

• Lead a team of Pharmacy Account Managers supporting multiple state Medicaid Pharmacy programs delivering consultative services with a high NPS and operational excellence.
• Provide strategic consultative pharmacy services to state Medicaid leadership advising them on all aspects of a Medicaid pharmacy benefit.
• Aligns with State Sector Leads and Account General Managers on client needs and VOC, partnering with Product and pharmacy leadership team.
• Assesses market trends, customer segments, and drives internal and external value proposition and message for GainwellRx.
• Partners with Pharmacy executive team in developing and delivering pharmacy market and solution training to state account teams.
• Aligns with Product team and Growth team for field campaigns, training, webinars, and client presentations.
• Drives new solution ideas, partners with states on new concepts, and works with product & engineering teams to deliver models to support them.
• Collaborates with Marketing on GainwellRx overall market message, media strategy, and GTM strategy.
• Supports state needs through RFP and bid proposals.
• Partners with Pharmacy executive team to drive business strategy and business development through market and competitive insights and analysis.
• Connect market insights into growth strategies and solution pipeline strategies.
• Drives key initiatives in support of strategy, pharmacy growth, and business development.
• Drives market analysis in support of business development projects and senior leadership key initiatives.
• Serves as an industry expert on GainwellRx, interfacing with external clients, vendors, and business partners.
• Collaborates across account teams, sales teams, product teams, and other shared service functions.

Senior Director, Rx Account Management

Project Manager

• assist in keeping projects moving to deliver better health and human services outcomes
• lead one or more large project management teams
• spearhead project planning, tracking and oversight of assigned staff
• communicate project metrics/status and recommend program changes
• create project schedules, program definitions, budgets and objectives
• prepare detailed SOW and assist with new proposal efforts and business development

Project Management Advisor

Call Center Representative

• Handle inbound calls from members and providers, delivering accurate information related to healthcare benefits, eligibility, and services.
• Research and resolve inquiries efficiently while following established procedures and compliance guidelines.
• Document customer interactions clearly and accurately in multiple systems during live calls.
• Meet performance expectations including quality standards, service levels, and productivity goals.
• Contribute to a collaborative team environment focused on delivering reliable and responsive support.

Call Center Healthcare Representative

Designer

• Head up technical teams and workstreams as you design, develop, test and install complex database applications software — with server, client and web components
• Keep the team on the same page by overseeing relationships between application architects and developers to ensure design requirements result in flexible, reusable system components
• Create more satisfied clients by writing highly complex design, coding and testing documentation that yields purpose-built technical products that meet real needs
• Shine as an SME in the areas of development, domain, application design and database methodologies and best practices
• Show your know-how as you provide clients with technical consulting on highly complex projects by refining existing apps and designing new application modules and components
• Exercise your expertise by mentoring and guiding less experienced application designers

Advisor Application Designer

Claims Specialist

• Assist the Claims Manager with day-to-day Claims Team operations
• Provide training and guidance to team members
• Resolve claims issues by researching claim situations
• Generate required client reporting and support audits
• Assist with special projects and related team goals
• Research and analyze paid and denied claims, POS system issues, and pricing discrepancies

Professional Claims Analyst

Manager

• Responsible for supervising the day-to-day prepay, post-pay, prior authorization, and medical record review activities of a multidisciplinary team of Coders, Clinical DRG Auditors, and Nurse Reviewers.
• Oversees and manages the daily operations of the team by leading, assigning work, ensuring productivity and quality metrics are achieved, and analyzing production and workflow/processes to increase efficiency and quality.
• Consistently demonstrates effective change management by communicating changes timely and effectively; building commitment and overcoming resistance; supporting those affected by change; monitoring transition and evaluating results.
• Responsible for oversight and hiring of staff, retaining top talent, performance management, coordinating training and education, and providing leadership and mentorship to staff to build and improve skills to provide best-in-class practices to enhance efficiency, quality, and customer satisfaction.
• Monitor aging inventory, workload, assignments, productivity, and quality to ensure service level agreements, contract deliverables, and timelines are met.
• Evaluate and analyze productivity, utilization, efficiency, finding rates, savings, appeal overturn rate, and reviews completed by staff to identify opportunities for process improvements.
• Meet with clients and providers to discuss complex cases, trend analysis, exit and/or settlement conferences.
• Serve as a Subject Matter Expert to assess new tools, automation, product development, and clinical readiness; act as a resource for resolving escalated issues, and coach and mentor staff to develop a high-performing team.
• Analyze reports and data and identify trends and resources that improve the delivery of clinical review services.
• Manage and evaluate individual/team performance and take appropriate action to meet and/or exceed performance standards.
• Perform other functions as assigned.

Associate Manager, Clinical Review

Artificial Intelligence

• Translate organizational objectives into actionable AI strategies and deliver scalable, results-oriented solutions.
• Oversee the end-to-end implementation of AI technologies, including GenAI models for applications such as claims processing, documentation automation, and customer support tools.
• Build and manage a high-performing team of AI engineers, data scientists, and product managers, ensuring accountability and alignment with project timelines.
• Collaborate with cross-functional teams to integrate AI capabilities into Gainwell’s existing systems and ensure their operational success.
• Monitor AI project performance and lead continuous improvement efforts to meet evolving client needs and regulatory requirements.
• Ensure all AI implementations comply with HIPAA, CMS, and other healthcare standards, prioritizing data security and ethical practices.
• Drive efficiency and cost-effectiveness by identifying opportunities to streamline workflows and processes using AI technologies.

Vice President, AI Solutions

QA Engineer

• Serves as a Quality Assurance (QA) subject matter expert for the Customer Experience (CX) organization
• Performs quality evaluations across all channels
• Analyzes evidence to assess quality and improve performance
• Provides hands-on support for DDIs, GTGs, and projects
• Serves as peer coach, mentor, and provides work guidance
• Collects and analyzes quality and defect metrics

Senior Quality Assurance Professional

Product Designer

• design and deliver enterprise-level product solutions, leveraging user-centered design and modern development practices
• lead or guide the end-to-end product development lifecycle, ensuring solutions are scalable, integrated, cost-effective, and aligned with business objectives
• champion best-in-class UX principles, including accessibility (WCAG compliance), usability, and inclusive design
• collaborate cross-functionally with UX designers, developers, and business teams to ensure seamless and cohesive user experiences
• provide strategic product guidance to stakeholders, including feature recommendations, technology direction, and vendor selection
• ensure solutions align with customer business value, enhancing productivity and improving end-user interactions
• stay current with emerging technologies and UX trends, driving innovation in product design and delivery
• contribute to or lead proposal development and business growth initiatives
• mentor and guide junior team members, fostering a culture of collaboration, innovation, and excellence
• represent Gainwell through presentations, user groups, and industry forums, showcasing product capabilities and thought leadership

UX/UI Product Developer

Business Analyst

• Supports business, policy, and technical execution across MMIS and/or the Medicaid Pharmacy environment.
• Acts as the primary Domain SME and trusted advisor on business processes and regulatory impacts.
• Ensures compliance alignment and validates solution design.
• Lead and participate in requirements and design sessions with clients and teams.
• Develop and maintain domain design documentation and ensure accuracy of requirements.

Business Analyst – MMIS, Pharmacy

• Contribute skills to improve health and well-being for vulnerable communities
• Support PMO reporting and analytics, including executive dashboards, status reporting, variance analysis, and trend insights
• Own and maintain delivery management artifacts such as RAID logs, action trackers, decision logs, and integrated schedules
• Manage delivery cadences (weekly, monthly, quarterly), including preparation, input collection, follow-ups, and closure
• Partner closely with PMO Lead to manage time, priorities, and dependencies across multiple workstreams
• Support client-facing and internal meetings, including agenda prep, materials, notes, and action tracking
• Work across tools such as Excel, Power BI, ServiceNow, Smartsheet/MS Project, Jira/ADO, and SharePoint to ensure data consistency and traceability
• Help translate raw delivery data into clear communications for leadership and client stakeholders
• Proactively identify execution gaps, reporting risks, and follow-up items before they become escalations

Senior PMO Business Analyst

• Support the optimization of our telephony platform within the Performance Enablement Organization (PEO).
• Translate business, operational, and compliance requirements into clear, well-documented system configurations.
• Focus on hands-on configuration, testing, and documentation.
• Partner closely with operational leaders, Product Experience Owners (PXOs), reporting, enablement, and technology teams to configure, test, and maintain our telephony solution aligned to best practices and enterprise standards.

Operational Analyst – Telephony Product Configuration

• Support the optimization of Verint WFM platform within the Performance Enablement Organization (PEO).
• Translate business, operational, and compliance requirements into clear, well-documented system configurations.
• Configure, test, and maintain Verint solutions aligned to best practices and enterprise standards.
• Partner with operational leaders to understand business needs and pain points.
• Document all configuration decisions, dependencies, and impacts.
• Support enterprise governance standards for configuration, naming conventions, versioning, and change management.
• Operate effectively in an agile, matrix‑based environment.