Gainwell Technologies

Business Operations

• Analyzes, plans, and implements moderately complex operational process improvement needs
• Acts as a re-engineering consultant to other transformation teams in methods, techniques, and tools
• Works closely with Lean Six Sigma Black Belts and CX teams to document existing processes
• Conducts a thorough gap analysis to identify inefficiencies and suggesting improvements
• Writes and maintains clear, concise, and standardized Standard Operating Procedures (SOPs)
• Conducts periodic reviews and validations of process documentation to ensure compliance with operational standards
• Collaborates with the training department to align training materials with documented processes
• Creates and maintains documentation templates, tools, and resources

Business Process Consultant, Green Belt

• Facilitate Kaizen Events: Lead and manage kaizen event workshops to map out and design the designed state of processes
• Analyze and Improve Processes: Employ Lean Six Sigma methodologies to conduct thorough analyses of designed processes
• Project Management: Take ownership of process improvement projects from inception to completion
• Robust Reporting & Insights: Work closely with the CX Insights team to design and implement measurement systems that effectively track key performance indicators (KPIs), service level agreements (SLAs), and other relevant metrics
• Operational Readiness: Assess and ensure that all systems, processes, and technology are fully operational and ready for deployment before the go-live date
• Continuous Improvement: Lead initiatives to drive ongoing improvements in customer experience and operational efficiency
• Root Cause Analysis: Conduct in-depth root cause analysis to address and resolve issues that arise during DDI projects.

Business Process Consultant

Analyst

• Coordinate the adoption of information security best practices throughout the company based on user feedback and industry standards.
• Communicate effectively with internal teams to address user concerns and optimize security compliance.
• Support IAM operations efforts including access reviews, control execution, and audits.
• Participate and represent IAM on projects and team calls to ensure security requirements are achieved in compliance with standards and policy.

Senior Identity and Access Management Analyst

Solutions Engineer

• Provide thought leadership and technical direction to the data engineering team
• Understand and translate business requirements to data strategies
• Design, develop and enforce standards for data storage and governance
• Work closely with enterprise and application architects
• Develop, document and maintain overall view of data platform architecture
• Provide training for data engineers, platform engineers and ETL developers
• Document and publish technical principles and mentor the data engineering team

Experienced Solution Architect

Data Analyst

• Elicit, analyze data, and document business requirements for software development projects
• Work closely with stakeholders, end-users, project managers, and developers
• Help translate business objectives into technical solutions
• Support the software development lifecycle from inception to implementation
• Gather, analyze, and document functional and non-functional requirements
• Act as a liaison between stakeholders and technical teams
• Create and maintain SOWs, user stories, process flows, and training materials
• Support UAT, identify and resolve defects, and assist end-users during testing and go-live phases
• Assist with project planning, tracking, and change management

Senior Data Analyst

Pharmacist

• Serve as the primary clinical SME on pharmacy implementations
• Lead clinical and drug reference domains on pharmacy design, development, and implementations (DDIs)
• Be a primary point of contact with the state client pharmacy team during the DDI and hypercare phases
• Ensure benefit plan drug coverages are configured accurately to state client specifications and requirements
• Validate successful and accurate conversion of pharmacy data from other vendors and stakeholders
• Ensure all point‑of‑sale (POS) claims processing edits, pricing, return messaging, and configuration meet the business requirements of the client
• Work with engineering and pharmacy business analyst teams to configure automated PA rule sets and electronic prior authorization (EPA) question sets, including testing scenarios and validation with the client
• Track and document progress of clinical domain activities against requirements and timelines, and provide status reports to senior leaders
• Identify risks or issues, ensure they are documented and tracked, and work with appropriate stakeholders to resolve them
• Maintain a clear understanding of the operational readiness, certification, and delivery status of all Gainwell pharmacy implementations
• Provide subject matter expertise for pharmacy and drug rebate product development, sales pursuits, RFP responses, and DDIs
• Encourage and strengthen cohesiveness and team unity across the pharmacy business and stakeholders on all Gainwell pharmacy implementations
• Participate in corporate pharmacy team meetings

PBM Implementation Pharmacist

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 and nurture newer team members by providing guidance and support.
• Be a knowledgeable bridge between clients, project managers, and technical staff to 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 to support client’s technology goals.
• Help verify that all requirements have been met by approving and validating test results.

Senior Business Analyst – Benefit Plan Administration

• Help create the power in Gainwell’s processes as we develop purpose-built technologies and solutions that yield better health and human services outcomes.
• Share your expertise as you support the Business Process Services team in claims processing that adheres to policy guidelines.
• Meet production and quality requirements established by clients for timely claims processing.
• Use policy guidelines and criteria established by leadership to evaluate why a claim errored and make an adjudication decision.

Provider Enrollment Analyst

Call Center Representative

• Answer incoming calls promptly and professionally, addressing member or provider inquiries, and make outbound calls as needed.
• Ability to remain calm and professional in high-pressure situations.
• Accurately document all interactions in the system, ensuring records are updated and complete.
• Maintain confidentiality and comply with HIPAA and other healthcare regulations.
• Escalate complex issues to supervisors or appropriate departments when necessary.
• Meet or exceed performance metrics including adhering to standardized call scripting and quality guidelines, call handle time, customer satisfaction and adhere to a daily work, lunch and break schedule.

Healthcare Contact Center Agent

Operations

• Manage proposal production and operational processes while providing editorial support and work planning assistance on an as-needed basis throughout the pursuit lifecycle.
• Maintain and update standard proposal templates, production procedures, style guides, and operational documentation to promote consistency across proposal workflows.
• Manage the day-to-day relationship with the Gainwell Printing Services Provider and oversee proposal production activities for printed submissions to support timely and accurate proposal delivery.
• Support implementation and maintenance of AI-enabled tools and technologies to enhance proposal efficiency, quality, and operational effectiveness.
• Assist leadership with metrics tracking and reporting, process improvement initiatives, and lessons learned activities to support continuous improvement and operational scalability.
• Provide editorial, document formatting, and quality assurance support, as needed, to include creating shell files, formatting and maintaining resumes, managing RFP-specific conventions lists, and performing editing, proofreading, and quality reviews to promote consistency, clarity, responsiveness, compliance, and overall proposal quality.
• Develop integrated work plans, using Microsoft Project and related planning tools, as needed, including milestones, task dependencies, review cycles, and production timelines.

Proposal Operations Specialist

• Partners with Pharmacy executive team to drive business strategy and business development through insights and analysis
• Overall responsibility for Pharmacy program design, development, execution and performance
• Market surveillance, understanding of market demands and client pain points to ensure robust and competitive offering of Pharmacy programs, services, and solutions
• Provides analysis of financial performance, pharmacy business growth forecasts, business pipeline projections, and new solution value modeling
• Partners with VP of Growth, State Sector Leaders, and Account General Managers for analysis of bid pipeline and development of state strategies
• Supports state needs through RFP and bid proposals in support of the Pharmacy Center of Excellence organization
• Aligns proposal requirements to business execution plans
• Manages and optimizes vendor contracts
• Drives key initiatives in support of strategy, pharmacy growth, and business development
• Reports status of key initiatives and aligns resources across the organization for delivery of key strategies
• Supports executive team in development of growth plans and market strategies
• Drives development of strategy materials and presentations
• Drives analysis in support of business development projects and senior leadership key initiatives
• Supports analysis for Pharmacy segment P&L management
• Supports Pharmacy executive team on Rx cost optimization strategies
• Delivers analysis and support for business cases for new investments
• Helps drive 3rd party business development
• Leads industry relations and partnerships in support of GainwellRx
• 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
• Drives new ideas, partners with states on new concepts, and works with teams to deliver models to support them

Director, Pharmacy Strategy

• Support enterprise content and document management initiatives by performing a dual role as a Business Analyst and Data Analyst.
• Work closely with business stakeholders, clients, and technical teams to gather requirements, analyze data, and map end-to-end solutions within the C3M, FileNet, and CMOD domain.
• Elicit and document business and functional requirements, validating change requests, and ensure appropriate testing strategies and implementation plans are in place.
• Audit solution changes to ensure quality, compliance, and operational readiness.

Business Analyst – Content & Document Management, Infra

Program Manager

• Responsible for overall service delivery and satisfaction of assigned clients
• Achieving revenue and margin goals
• Ensuring quality and timeliness of client deliverables
• Identifying and assisting with development and execution of sales strategies
• Facilitating growth of professional staff
• Building and enhancing client relationships
• Supporting and/or leading corporate initiatives
• Driving overall HMS agenda within assigned commercial clients

Senior Director, Program Management

• Work collaboratively with the client and team members
• Research, validate and document business needs
• Ensure items are prepared for client meetings
• Assist with translating client requests
• Document updates for all reference updates/changes
• Work with the systems team on assigned system changes
• Assist with quarterly and annual CPT, HCPCS and diagnosis code updates

Business Analyst – Healthcare

• Conduct evidence‑based evaluations of drugs and drug classes using accepted clinical methodologies
• Develop and maintain Gainwell TCRs to support recommendations for Preferred Drug List (PDL) management
• Apply evidence‑based medicine principles to develop clinical PA recommendations and supporting documentation
• Review clinical and pricing data to support the Gainwell clinical PDL team
• Review and monitor prescription claims data and prescribing patterns identified as outliers
• Contribute to the development of Clinical Services publications produced on a weekly, monthly, quarterly, and as‑needed basis
• Support continuous quality improvement by identifying enhancement opportunities
• Provide support to client accounts during implementation, maintenance, and ongoing operations
• Promote collaboration and alignment across the pharmacy business