Gainwell Technologies

Software Engineer

• Codes, tests, debugs, implements, and documents highly complex programs
• Develops complex test plans to verify logic of new or modified programs
• Designs systems and programs to meet highly complex business needs
• Prepares detailed specifications from which programs are developed and coded
• Creates appropriate documentation in work assignments such as program code, and technical documentation
• Gathers information from existing systems, analyzes program and time requirements
• Prepares time estimates and justifications for assigned tasks and provides recommendations to project managers
• Supports project personnel in resolving fairly complex program problems
• Works with client and management to resolve issues and validate programming requirements within their areas of responsibility
• Provides technical advice on complex programming
• May serve as technical project lead; provides leadership and work guidance to less experienced personnel
• Conducts quality assurance activities such as peer reviews
• Provides consulting services in a technical and/or managerial capacity to management and technical staff

Programmer Analyst

Manager

• Cultivate client relationships and be the voice of Gainwell as a trusted advisor and thought leader
• Manage the operations of your account, including SLAs, security remediation, outage management, resource oversight, staffing, project health, implementations, and quality assurance
• Understand the data and own the outcomes for your client
• Develop a client-centered innovation agenda to proactively engage with the client on their business needs and goals
• Harness Gainwell's innovative spirit to meet and exceed contractual commitments
• Guide and mentor the delivery and operations team for your account
• Manage the financial quality of the account

Account General Manager

• Help power critical healthcare claims solutions at Gainwell.
• Work on complex, high-impact systems, partner with technical leadership, solve meaningful production and integration challenges.
• Design, build, test, and support complex applications and batch solutions in a C, Unix/Linux, and Oracle environment.
• Own key technical deliverables across the full development lifecycle.
• Contribute to modernization, release readiness, and continuous improvement across a critical healthcare technology platform.

Senior C/Unix Batch Developer – Healthcare Claims

Full-stack Engineer

• Lead the development and modernization of healthcare claims solutions
• Mentor engineers, drive technical delivery, and partner across teams
• Own technical delivery across the software development lifecycle, from design through release and support
• Guide architecture, development, and modernization of C/Unix-based healthcare claims applications
• Partner with product, business, and operations teams to align solutions with client needs
• Drive engineering excellence through code quality, testing, release readiness, and continuous improvement

Technical Lead – C/Unix Batch Development, Healthcare Claims

Customer Support

• 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

Senior Customer Support Assistant

Analyst

• Support the execution and optimization of enterprise Verint Quality Management (QM) and Automated Quality Management (AQM)
• Translate business, operational, and compliance requirements into clear, well-documented system configurations
• Assist with pre-go-live testing, post-go-live stabilization, and production validation
• Maintain clear documentation to enable knowledge transfer and reduce single-point dependency
• Partner with Quality leaders and operational stakeholders to understand business needs
• Support reporting and enablement teams by providing configuration context and functional inputs
• Support configuration of Automated Quality Management (AQM), including eligibility rules and automation logic
• Gather, analyze, and document detailed business and functional requirements

Operational Analyst – Verint Quality Execution

Data Entry

• Enter and verify claims information, supporting documentation, and healthcare records with a high degree of accuracy.
• Review claims forms and related documents to ensure data is complete, accurate, and compliant with established procedures.
• Maintain confidentiality and security of sensitive healthcare and member information.
• Meet established productivity, quality, and accuracy standards while managing daily workloads.
• Utilize multiple systems and Microsoft Office applications to support claims processing and operational objectives.

Healthcare Data Entry Specialist

IT Support

• Serve as the first point of contact for healthcare providers
• Answer inbound calls and respond to EDI-related inquiries
• Research and troubleshoot provider issues
• Conduct outbound follow-ups for timely resolution
• Process provider and member updates while maintaining standards

EDI Helpdesk Representative

• Own the full vendor management lifecycle for outsourced contact center partners
• Set vendor expectations and performance standards
• Develop and execute Statements of Work (SOWs)
• Manage vendor performance through weekly operating reviews
• Serve as the primary point of contact between vendors and internal stakeholders
• Identify performance risks and improvement opportunities
• Establish and enforce vendor management standards
• Partner with internal teams and vendors for improvement and innovation

CX Vendor Manager

Pharmacist

• Support members, providers, and pharmacies by responding to pharmacy-related inquiries, benefit questions, prior authorization requests, and claims-related issues
• Research and resolve pharmacy claims, eligibility, coverage, and medication-related concerns while maintaining service level expectations
• Review, document, and process pharmacy transactions and requests in accordance with client, regulatory, and operational guidelines
• Utilize multiple systems and resources to accurately investigate issues, provide resolutions, and maintain complete documentation
• Collaborate with internal teams, healthcare professionals, and external stakeholders to support quality service delivery and member satisfaction

Certified Pharmacy Technician

Business Analyst

• Play a critical part in ensuring Gainwell is meeting our clients’ objectives in important areas
• Help coordinate a business analyst team’s duties and activities on IT projects
• Nurture newer team members by providing guidance and support
• Be a knowledgeable bridge between clients, project managers and technical staff
• Define, document and share business requirements and expected impact
• Work with the client to develop business specs at the start of a technical project
• Analyze, plan, design, document or make recommendations to improve business processes
• Help verify that all requirements have been met by approving and validating test results
• Use basic analytical or relational database software — such as Excel or SQL

Senior Business Analyst

Consultant

• Analyze and apply state policy in a variety of situations, including client meetings and suspended claims reviews
• Serve as a subject matter expert on State policy and provide consultation and guidance to clients
• Respond to client referrals in a timely manner
• Recommend process improvements and approved modifications to support operational effectiveness and industry competitiveness
• Identify potential opportunities for additional products or services and collaborate with the business development team as needed

Nurse Consultant

• Play a critical part in ensuring Gainwell is meeting our clients’ objectives in pharmacy benefit management (PBM) services
• Support Preferred Drug List (PDL) and supplemental rebate implementations and configurations
• Support PDL and supplemental rebate operations and maintenance on established accounts
• Work with a team of pharmacy clinicians and subject matter experts to configure PDL and rebate systems to deliver services to our state clients
• Apply analytical skills to evaluate and model various rebate scenarios, providing insights for decision-making
• Perform system updates related to PDL and rebate configurations to ensure accuracy and compliance
• Analyze, plan, design, document or make recommendations to improve business processes to support client’s technology goals
• Execute testing for PDL and rebate system changes to ensure functionality and reliability
• 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 – Preferred Drug List

• Work with the client, Gainwell business teams, Gainwell technical teams, and other vendors to identify and develop business and technical solutions
• Analyze CoreMMIS reports to resolve discrepancies/errors
• Develop requirements, business designs, and business processes for required system changes
• Develop and/or coordinate creation of ad hoc reports to monitor, support, and analyze Provider Enrollment processes
• Participate in internal and external committees and workgroups as requested
• Project a positive, professional attitude in a fast-paced environment
• Effectively manage time and work independently in a strong team environment

Experienced Business Analyst – Provider Enrollment

Content Writer

• Process Documentation: work closely with Lean Six Sigma Black Belts and CX teams to document existing processes through detailed flowcharts, process maps, and written descriptions
• SOP Development: write and maintain clear, concise, and standardized Standard Operating Procedures (SOPs) for all CX functional areas
• Quality Assurance: conduct periodic reviews and validations of process documentation to ensure it reflects actual operations and complies with operational standards
• Training Support: collaborate with the training department to align training materials with documented processes
• Documentation Standards: develop and implement documentation standards and best practices to ensure consistency and usability across all CX processes
• Collaboration: work with cross-functional teams to gather information, clarify process details, and ensure comprehensive documentation
• Reporting and Communication: track and report progress on documentation projects, ensuring deadlines are met and deliverables are of high quality