Gainwell Technologies

Business Analyst

• contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve
• Act as the primary functional liaison between the client, MCOs, and our internal technical teams for all MMIS operations workflows
• Lead requirements gathering sessions and "triage" meetings to address any surges in defects, change requests (CRs), and operational gaps
• Manage client expectations regarding system capabilities, timelines for fixes, and regulatory constraints
• Analyze and document complex requirement issues namely Claims (FFS & Encounters), Financials, Capitation, Provider Enrollment and others
• Validate that proposed technical solutions solve the business problem before development begins
• Investigate root causes of systemic issues reported by Providers or MCOs (e.g., mass claim denials, capitation payment errors, EDI rejection loops)
• Collaborate with the Operations team to distinguish between "system defects" and "user training gaps," creating workarounds or documentation as needed
• Serve as the Subject Matter Expert (SME) on Medicaid workflows, ensuring compliance with federal Centers for Medicare & Medicaid Services (CMS) and local (District) regulations

Experienced Medicaid Business Analyst

Operations

• Supervise and coordinate the daily operations of the claims department, ensuring timely and accurate claims processing.
• Establish and monitor performance metrics, service level agreements (SLAs), and department goals.
• Coach, mentor, and develop claims staff, including performance evaluations and training initiatives.
• Review and resolve complex or escalated claims issues, ensuring compliance with company policies and regulatory standards.
• Implement process improvements to enhance efficiency, accuracy, and customer satisfaction.
• Oversee the use of claims management systems and ensure data integrity and confidentiality.
• Collaborate with underwriting, customer service, legal, and finance teams to address interdepartmental issues and support business objectives.
• Prepare and present regular reports on claims operations, trends, and key performance indicators (KPIs) to senior management.
• Maintain up-to-date knowledge of industry regulations, trends, and best practices.
• Handle customer complaints and inquiries with professionalism, ensuring prompt resolution and positive outcomes.

Claims Operations Manager

Account Manager

• Manage the delivery of operational services for an account (people, processes, and technology).
• Directs daily work activities and priorities, driving innovation, cost efficiency, and performance optimization.
• Build, develop, motivate, and lead teams of leaders and individual contributors, supporting employees through ongoing execution of management activities.
• Establish and effectively lead weekly, monthly, and quarterly routines to achieve Client contractual SLAs and bonus targets, assigned goals, objectives, and account scorecard deliverables.
• Create conditions for success by removing obstacles and championing change to drive employee awareness and a connection to their work and contributions.
• Identify and manage existing and emerging risks from business activities and implement mitigation strategies to improve performance.
• Maintain budgets and lead and contribute to projects (Business as Usual [BAU] and Transformation).
• Partner with other leaders to positively influence the financial impact for their respective business area(s).
• Contribute to developing new service offerings and enhancements based on market trends and customer needs.

Account Delivery Manager

Manager

• Oversee the full Florida casualty case management lifecycle to ensure operational timeliness, efficiency, and productivity.
• Manage operational tasks such as signing checks, monitoring mailroom activities, and overseeing document notarization as needed.
• Monitor SLA performance, throughput, backlog levels, and key lifecycle metrics across Shared Services and Recovery.
• Identify performance gaps, workflow bottlenecks, and risk areas, escalating to leadership as necessary.
• Serve as the primary AHCA-facing contact for Florida casualty-related inquiries, escalations, reports, and documentation requests.
• Ensure all RFQ requirements for the Casualty Manager role are met, including full-time dedication to the contract, no assigned caseload, and sufficient qualified staffing.
• Coordinate responses to AHCA audits, operational reviews, and data requests, ensuring accuracy and timely submission.
• Partner with Shared Services and Recovery Directors to resolve lifecycle handoff issues, delays, and SLA risks.
• Act as the unifying point of accountability across all functional areas supporting the Florida casualty lifecycle.
• Perform a quality assurance review of 10 cases per caseworker per month.
• Monitor workload distribution, performance trends, and staffing sufficiency, recommending adjustments to Directors where needed.
• Prepare and deliver Florida-specific operational and SLA reports for internal leadership and AHCA.
• Identify process breakdowns or Florida-specific pain points across the end-to-end lifecycle.
• Collaborate with Shared Services and Recovery leadership to implement workflow improvements that enhance efficiency and consistency.

Casualty Subrogation Manager

Call Center Representative

• Supervise, coach, and develop remote call center agents and team leads
• Monitor and manage key performance indicators
• Conduct performance evaluations, coaching sessions
• Handle escalated customer concerns
• Ensure adherence to policies and regulatory requirements

Subrogation Call Center Supervisor

Technical Writer

• Write, edit, and manage the development of multi-vendor stakeholder communications and provider communications on behalf of Gainwell client
• Partner with internal subject matter experts to gather information and assess communication needs
• Develop and maintain strong knowledge of Gainwell subsystems
• Provide high-touch client experience by anticipating needs and ensuring quality standards
• Manage the full content development lifecycle from drafting to publication

Professional Technical Writer

Program Manager

• Track and monitor contract deliverables, milestones, risks, and issues; escalate concerns appropriately.
• Assist in interpreting contract language and ensuring relevant teams understand obligations and expectations.
• Maintain awareness of SLA metrics and collaborate with internal teams to drive performance and timely reporting.
• Assist in managing day‑to‑day client interactions, providing timely and professional communication.
• Prepare meeting materials, agendas, status reports, and follow‑up documentation for client and internal meetings.
• Serve as a reliable backup to Project Director, supporting continuity of service and client satisfaction.
• Partner with leads across Operations, IT, Analytics, Quality, Compliance, Legal, and Finance to support coordinated contract delivery.
• Facilitate communication among internal stakeholders to ensure alignment on priorities, deadlines, and responsibilities.
• Assist in gathering, validating, and summarizing data for client requests, program reviews, and internal analysis.
• Contribute to the development and maintenance of project plans, process documentation, workflows, and dashboards.
• Maintain organized documentation, contract files, and client communications in accordance with company standards.

Data Entry

• Manual entry of medical claims into the DHS MMIS system
• Efficient mail preparation for RTP (Returned to Provider) letters
• Accurately capture data from medical claims and attachments
• Process documents within a data capture solution
• Verify and review data
• Work with Microsoft Office programs, including Excel, Word and Outlook
• Crosstrain with other departments, such as mail room and document control
• Meet established production and quality standards
• Support all departmental initiatives to improve overall efficiency.

Data Entry Specialist

• Analyze, plan, design, document and make recommendations to improve business processes to support client’s technological aspirations
• Be a supportive bridge between clients, project managers and technical personnel to define, track and communicate business requirements and their expected impact by building basic conceptual data and process models
• Create, execute or analyze basic test scenarios to verify that client requirements are built into system design
• Help verify that all requirements have been met by approving and validating test results
• Exercise your ability to use basic analytical or relational database software — such as Excel or SQL — to quantify the anticipated impact of work

Business Analyst – Amazon Connect

• Creating and maintaining operational reports across business process areas
• Ensuring internal stakeholders receive accurate and timely insights
• Analyzes reporting needs, develops automated reporting solutions using tools such as Power Query
• Supports BAU (business‑as‑usual) reporting on predictable weekly and monthly schedules
• Contributes to automation and process‑improvement projects, helping streamline data workflows and operational efficiency
• Collaborating with operational leaders to ensure reporting accuracy, alignment, and timely delivery

• support the Advancing Interoperability and Improving Prior Authorization Processes project
• contribute to operational readiness activities, requirements documentation, and testing efforts
• document current operational workflows and assist in identifying process gaps or improvement areas
• support development of future‑state process flows and operational readiness materials
• assist with preparing staffing inputs, workload assumptions, and operational support documentation
• maintain traceability of requirements throughout the project lifecycle
• assist in developing test cases and acceptance criteria with an operational focus
• participate in system, user acceptance, and operational readiness testing activities
• support project planning activities related to analysis and readiness
• assist in virtual and occasional in person training for impacted operational staff

Business Analyst – Prior Authorization, Interoperability

Architect

• Responsible for the architecture, design, engineering, and operational lifecycle of enterprise firewall platforms across on‑premises data centers and public cloud environments.
• Serve as the technical authority for Firewall technologies, ensuring secure, scalable, and resilient network security architectures.
• Partner with the CISO office to lead the end to end architecture of firewall solutions across on prem, AWS, and Azure environments.
• Define reference architectures, design patterns, and standards for Palo Alto firewalls.
• Ensure firewall architectures support high availability, resiliency, segmentation, and zero trust principles.
• Engineer and assist Managed Services vendors to deploy and maintain Palo Alto Networks firewalls.
• Design and implement security policy frameworks, NAT strategies, routing, and traffic flows across hybrid environments.
• Lead major firewall initiatives, including new deployments and upgrades.
• Architect firewall solutions integrated with AWS and Azure.

Senior Firewall Architect – Engineer

Client Services Representative

• support client success by ensuring the accurate and timely delivery of client data files, letters, and reporting
• oversee end-to-end workflows as claims progress through audit, QA, and review processes
• perform detailed, quality-focused analysis and QA of client data files and letters to ensure accuracy and compliance
• leverage tools, reports, and metrics to proactively perform first-level analysis of errors related to files, letters, and overall workflows
• analyze complex data sets to identify trends, issues, and actionable insights
• conduct claim research as requested by Account Management or Clients
• translate client-specific requirements and processes between technical and non-technical partners
• collaborate with implementation teams and internal stakeholders to ensure client deliverables meet requirements
• participate in client calls and provide clear, professional updates on KPIs, reporting, and claim status
• monitor and proactively drive improvements related to KPIs, including recovery conversion, fallout management, and client SLAs
• provide regular updates to leadership on workflow status, trends, and key metrics

Client Services Analyst II

• Responsible for the management of at least one account or significant project.
• Responsible for managing the client contract, relationship management, and ensuring that HMS operations perform according to contractual commitments.
• Prepares, monitors, and manages budget and revenue expectations for assigned client(s).
• Works with client(s) to develop project approach and implementation plans.
• Oversees development and implementation.
• Reports to management on progress toward strategic account growth and business goals.
• Communicates/interfaces regularly with client(s).
• Directs HMS contract operations to ensure successful delivery of services to client(s).
• Identifies and continually seeks new sources of revenue.

Account Manager II

Software Engineer

• Own and evolve an enterprise-ready Copilot enablement approach: usage patterns, prompt standards, and governance for regulated environments.
• Create and curate a repository-backed library of reusable prompt files (.github/prompts) for common engineering scenarios (bug fixes, brownfield enhancements from user stories, refactoring, test generation, security remediation).
• Author and maintain custom instruction files (repository and organization patterns) to enforce coding standards, architecture conventions, error handling, logging, and testing practices.
• Design interactive ‘guided’ prompts that ask one question at a time, minimize friction for low adopters, and require user confirmation before applying code changes.
• Collaborate with teams to integrate Copilot into day-to-day workflows in Visual Studio and GitHub (PR templates, checklists, review guidance).
• Define and implement guardrails so AI-assisted code can’t land without required quality and security signals (tests, reviews, and automated scanning).
• Configure and enforce GitHub Advanced Security practices where applicable (CodeQL code scanning, dependency review/alerts, secret scanning/push protection) and integrate results into PR gating.
• Establish measurement for AI-assisted development: Copilot usage metrics (suggested vs added LOC, acceptance actions) and repo outcomes (review cycle time, defect inflow proxies, security findings), with clear limitations and directional interpretation.
• Partner with AppSec and compliance stakeholders to ensure safe handling of sensitive data in prompts, logs, and test artifacts.
• Contribute to and review C#/.NET codebases (ASP.NET Core, EF Core) to ensure Copilot guidance and templates match real architecture and patterns.
• Build small, maintainable developer tooling and automation (e.g., GitHub Actions, internal utilities, code generators where appropriate) that complements Copilot rather than replacing engineering discipline.
• Create and maintain sample reference implementations and ‘golden paths’ that demonstrate secure patterns, test-first fixes, and high-quality PRs.
• Develop LLM-powered workflows on Azure (Azure OpenAI) to support developer experience and engineering insights (e.g., PR summarization, guided debugging, quality dashboards).
• Implement prompt contracts, tool/function calling patterns, and evaluation harnesses for reliability, cost, and safety.
• Where needed, build retrieval-augmented generation (RAG) pipelines and connectors to enterprise knowledge sources with grounding/citations.