Gainwell Technologies

Assistant

• Manage all casualty and estate functions involving state Medicaid beneficiaries or deceased Medicaid beneficiaries
• Handle intake, maintenance, claims review, case management, settlement, and related activities within the assigned caseload
• Ensure processes meet HIPAA and government security requirements for sharing and storing PHI
• Oversee 700–1,000 subrogation cases simultaneously
• Communicate with attorneys, insurance adjusters, medical providers, court staff, recipients, family members, and clients via inbound and outbound calls
• Prepare and manage correspondence, liens, claims, and related documentation
• Perform basic and advanced document and legal reviews
• Verify beneficiary eligibility and maintain accurate documentation
• Validate third-party liability, probate, and asset research findings
• Analyze information from multiple sources to determine case status and recovery potential
• Process and resolve claim or lien disputes
• Conduct follow-ups on case status, payments, and settlements
• Negotiate and finalize claim or lien settlement amounts
• Execute and file notarized documents with applicable county offices
• Prioritize case events, payment issues, and revenue-impacting deadlines
• Maintain accuracy, timeliness, productivity, file management, and phone metric standards

Assistant, Case Management

Business Analyst

• Coordinate a business analyst team’s duties and activities on IT projects
• Provide guidance and support to newer team members
• Define, document, and share business requirements and expected impact with clients, project managers, and technical staff
• Develop business specifications at the start of technical projects
• Analyze, plan, design, document, or recommend improvements to business processes supporting clients’ technology goals
• Approve and validate test results to verify requirements have been met
• Use Excel or SQL to quantify anticipated business impact

Senior Business Analyst – Financial

Provider Enrollment Specialist

• Support provider enrollment, maintenance, and renewal activities for the WV Medicaid program
• Review and process Medicaid provider enrollment applications, renewals, and maintenance requests
• Follow WV Medicaid-approved guidelines, the ACA, federal requirements, and established procedures
• Conduct extensive independent research
• Participate in special projects with occasional onsite requirements

Call Center Representative

• Answer inbound member calls and provide accurate information regarding healthcare benefits, eligibility, and available services
• Research member inquiries, resolve issues, and respond within established service level agreements (SLAs)
• Accurately document member interactions, resolutions, and follow-up activities within the customer relationship management (CRM) system
• Collaborate with team members, leadership, and business partners to resolve member concerns and deliver an exceptional customer experience
• Conduct outbound calls to members as needed to provide updates, obtain additional information, or support business initiatives
• Assist members throughout California by telephone while navigating multiple computer systems
• Help members access the healthcare information and services they need

Bilingual Healthcare Call Center Representative

• Engage in daily standup meetings with the Medical Policy and internal modules
• Create and update implementation strategies and design checklists for assigned healthcare policies
• Analyze dependencies and assist the Project Manager in identifying risks and issues
• Coordinate and lead brainstorming sessions for policy research and design
• Assess impacted operational areas and document required documentation
• Liaise with operational and development teams throughout policy progress and releases
• Define scope with DHCS and the Project Manager for each assigned medical policy
• Develop strategy and lead execution of provider manuals, bulletins, and messaging campaigns to Provider Portal External users
• Assist and direct artifact updates, including scripts, standard operating procedures, and User Guides
• Assist with operational unit training, questions, answers, and escalations
• Collaborate with Publications, Provider Training, and Operational Training delivery teams
• Perform other duties assigned by the Project Manager

Business Analyst – Healthcare, UAT

Pharmacist

• Provide knowledgeable responses to basic client questions; elevate more complex cases to appropriate staff as needed
• Put your skills to work to solve client problems, update account history and follow up with clients to confirm their inquiry or request is resolved
• Adhere to the client’s SLAs and consistently meet production targets
• Collaborate with team members, management and clients to resolve client inquiries; cross-train new resources in customer service processes
• Process client inquiries more efficiently and effectively by reviewing and recommending changes to procedures and workflow

DAPO Specialist – Pharmacy

Designer

• Design, develop, install, and test applications software
• Collaborate with teams to create documentation and testing strategies
• Ensure successful application integration and deployment
• Define project requirements and develop functional specs

Associate Application Designer

Healthcare Contact Center Agent

• Code, test, debug, implement and document moderately complex programs
• Analyze, design and write specs and reqs from which we develop and code programs
• Evaluate existing systems and programs; assist project manager in assigning tasks
• Liaise with clients and management to provide technical consulting on complex programming projects
• Develop test plans and participate in QA activities

Application Designer

Advisor

• Lead product strategy for Medicaid claims-related domains, translating member, provider, benefits, clinical, and finance needs into clear product outcomes and domain roadmaps
• Shape the transformation of core adjudication capabilities by defining modern product direction, platform opportunities, and domain-level investment priorities
• Develop a deep understanding of Medicaid program operations, claims workflows, regulatory and policy context, client pain points, market dynamics, and ecosystem shifts
• Use product discovery, customer research, workflow analysis, data, and experimentation to validate problems, prioritize opportunities, and reduce delivery risk
• Partner with engineering, architecture, design, operations, implementation, sales, and client-facing teams to align domain strategy with feasible, scalable product execution
• Frame ambiguous domain and platform decisions, evaluate tradeoffs, and bring recommendations forward with clear rationale
• Create and evangelize product narratives that help stakeholders understand the transformation vision
• Define success measures for domain outcomes and use qualitative and quantitative insights to evaluate adoption, operational impact, user experience, and product performance
• Identify new product opportunities within Medicaid claims

Advisor, Product – Medicaid Solutions

• Answers telephones and responds to moderately complex customer questions and/or forwards calls to appropriate personnel
• Research customer inquiries and responds to appropriate parties in a timely manner
• Interfaces with team personnel, management, and customers in reference to customer service issues
• Reviews client reports on a weekly basis to ensure data integrity; prepares and submits reports to management
• Monitors daily transactions to ensure policy and procedures are in accordance with service level agreement

Member/Provider Call Center Lead

• Answers telephone calls using an automated system and responds to basic to moderately complex member and provider questions and/or forwards calls to appropriate personnel.
• Research provider and member calls/inquiries and responds to appropriate parties in accordance with service level agreements (SLAs).
• Records calls in a customer relationship management (CRM) ticketing solution, resolves written member requests/inquiries and updates member history with results of inquiry to include proper documentation.
• Interfaces with team personnel, management, and customers in reference to customer service issues.
• Conducts outbound calls to members in response to voicemail inquiries, customer direction, or other business needs.

Provider, Member Call Center Agent

Manager

• Supervise the quality review program, creating policies and processes relating to quality and ensuring continuous conformance with appropriate standards, regulations, and contractual agreements.
• Develop, implement, and maintain quality assurance processes and performance benchmarks for DRG validation, inpatient coding, and outpatient coding/billing audits.
• Supervise and mentor clinical auditors and coding specialists; provide education, coaching, and performance feedback.
• Monitor and report key performance indicators (KPIs) for audit accuracy, productivity, and interrater reliability.
• Identify trends, root causes, and opportunities for improvement in documentation or coding accuracy.
• Analyze audit results, denial trends, and payer findings to identify systemic issues and recommend corrective actions.
• Prepare and present regular reports and dashboards for leadership, highlighting performance metrics, audit outcomes, and improvement initiatives.
• Support compliance and revenue integrity efforts by ensuring the accuracy of coded data used for reimbursement, quality reporting, and analytics.
• Develop and deliver training programs for coding, clinical, and quality assurance teams.
• Stay current with evolving CMS regulations, ICD-10-CM/PCS updates, and industry standards for inpatient coding and DRG assignment.
• Drive continuous quality improvement initiatives to enhance effectiveness and efficiency.
• 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.
• Manage and evaluate individual and team performance, and take appropriate action to meet and/or exceed performance standards.
• Perform other functions as assigned.

Assistant, Case Management

Senior Business Analyst – Financial

Provider Enrollment Specialist

Bilingual Healthcare Call Center Representative

Business Analyst – Healthcare, UAT

DAPO Specialist – Pharmacy

Associate Application Designer

Healthcare Contact Center Agent

Application Designer

Advisor, Product – Medicaid Solutions

Healthcare Contact Center Agent

Healthcare Contact Center Agent

Member/Provider Call Center Lead

Provider, Member Call Center Agent

Associate Manager, Inpatient/Outpatient Coding Review