Advisor, Claims Business Analyst

Gainwell Technologies

Advisor Claims Business Analyst supporting end-to-end claims workflow analysis and complex issue resolution. Leverage expertise in Medicaid claims adjudication and data analysis for operational improvements.

Posted 6/5/2026full-timeRemote • Nevada, New York • 🇺🇸 United StatesSeniorLeadWebsite

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

Support end-to-end claims workflow analysis, configuration support, and complex issue resolution within the MMIS ecosystem
Provide advanced (L2) support for claims operations by leveraging deep expertise in Medicaid claims adjudication, data analysis, and cross-functional collaboration
Drive root-cause analysis, identify trends, and recommend solutions that improve first-pass rates, reduce denials, and support client and organizational objectives
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

What you’ll need

9+ years of experience in claims business analysis, configuration, or healthcare operations
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 preferred

Benefits

Comp & perks

Flexible vacation policy
Educational assistance
Comprehensive leadership and technical development academies

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

claims workflow analysisMedicaid claims adjudicationdata analysisroot-cause analysisSQLICD-10CPTbillingadjudication rulesreporting

Soft Skills

problem-solvingcommunicationcollaborationstakeholder engagement