Gainwell Technologies

Account Executive

• Serve as the primary executive point of contact for state Medicaid clients, including Pharmacy Directors and senior leadership.
• Build and maintain strong client relationships, acting as a trusted advisor on all aspects of the Medicaid pharmacy benefit.
• Provide comprehensive oversight of pharmacy clinical operations, including prior authorization and utilization management.
• Develop and execute account strategies aligned with organizational and client goals.
• Own account‑level financial performance, including cost‑of‑care outcomes and budget alignment.
• Lead, mentor, and develop a team of account managers, clinical leaders, and operations staff.

Pharmacy Account Director

Software Engineer

• Design and deliver complex, comprehensive product-based business solutions
• Lead or monitor the product implementation process
• Provide strategic product advice to clients
• Be a knowledge expert in emerging technologies
• Manage and motivate a team of product development experts

Product Developer

Data Engineer

• Assist in building and maintaining data pipelines for ingesting, transforming, and loading data
• Support ETL/ELT processes for structured and unstructured data sources
• Work with engineers to troubleshoot and improve pipeline performance
• Write and optimize SQL queries for data extraction and transformation
• Perform data cleansing, validation, and basic transformations
• Support development of reusable data components and scripts
• Assist in managing and monitoring data workflows in cloud environments (AWS, Cloudera, etc.)
• Support execution and scheduling of batch and real-time data jobs
• Help maintain development, test, and production environments
• Perform basic data validation and quality checks
• Document data flows, pipelines, and transformations
• Support adherence to data governance and security standards
• Work with cross-functional teams (engineering, analytics, product) to understand data requirements
• Participate in code reviews, team discussions, and agile ceremonies
• Continuously learn new tools, technologies, and best practices in data engineering

Architect

• Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities
• The principal role of the PAI architect is to be a liaison between the customer and our Abacus partners
• Ensure the end-to-end solution for each client/project is fully supported with no gaps
• Technical project documentation – Creating state specific artifacts such as ADDs, RTMs, data flow diagrams, project guides
• Support go-live activities – ensure that documents are completed and approved
• Security documentation and approvals – ensure that we have the most current Abacus generated security reports
• Coordinate the definition of state specific business rules - work with Abacus and state resources to define and resolve anomalies found during data ingestion
• SFTP/MFT implementation - ensure that these connections are established, documented, and supported
• SharePoint management – manage SharePoint sites to help share PHI and non-PHI document with our external vendors
• Problem resolution and issue management – support our solution with unanticipated one-off requests

Application Architect

Data Scientist

• Designs, develops, programs methods, processes and systems to consolidate and analyze unstructured, diverse big data sources using machine learning and predictive modeling tools.
• Builds analytic models to identify and quantify solutions to business problems.
• Interprets and communicates insights and findings from analysis and experiments to client, service, and business managers.
• Provides leadership and work guidance to less experienced personnel towards build of software programs, algorithms and automated processes to cleanse, integrate and evaluate large datasets from multiple disparate sources.
• Champions global initiatives in data sciences.

Principal, Data Sciences

Analyst

• Reviews Medicaid Drug Rebate payments from drug manufacturers to identify rebate disputes and resolve outstanding balances
• Contact pharmacy and medical providers to verify claims data
• Contact drug manufacturers for information on disputed rebates
• Provide training for new hires and act as a subject matter expert to team
• Assist in required CMS reporting and invoicing as needed
• Act as backup for Drug Rebate Supervisor tasks as needed
• Assist the Supervisor in monitoring dispute workflow
• Lead efforts to focus efforts on the highest materiality disputes
• Assist with claim load file quality validation
• Research disputed pharmaceutical utilization to prepare dispute resolution proposals
• Negotiate with drug manufacturers to resolve disputes fairly and accurately
• Complete required productivity tracking reports
• Track and prioritize dispute resolution activities on an ongoing basis
• Review and resolve invoices in assigned workflow queues on a daily basis
• Follow up with drug manufacturers to secure payment for unpaid invoices
• Interact with internal and external customers to accomplish goals
• Other tasks as directed

Senior Drug Rebate Analyst

• Review, research, and resolve medical claims in accordance with established processing guidelines and procedures.
• Analyze claims issues and coordinate with internal departments to ensure timely and accurate resolution.
• Prepare and process claim-related documentation, including Return to Provider (RTP) forms when required information is missing or invalid.
• Manage multiple priorities while maintaining productivity, accuracy, and service-level expectations.
• Communicate claim status, workload updates, and potential issues to leadership and business partners as appropriate.

Medical Claims Resolution Analyst

Consultant

• Conducting clinical and financial pre-payment compliance reviews to detect, combat, and eliminate fraud, waste, and abuse in the Medicaid program.
• Consulting on the development and implementation of pre‑payment review policies and guidelines that support OIG program objectives.
• Perform comprehensive medical record reviews and analyze complex datasets and systems.
• Develop, establish, and implement pre‑payment review criteria across multiple service areas.
• Process pre‑payment reviews according to medical necessity criteria, administrative code, and other requirements.

Pre-Payment Review Nurse Consultant

Program Manager

• Manage delivery of end-to-end product solution across multiple delivery areas
• Lead programs to successfully deliver and support complex product solution implementations
• Oversee planning, execution, risk management, stakeholder alignment, and delivery across multiple areas
• Serve as the primary point of coordination between business stakeholders and delivery teams throughout the implementation lifecycle

Program Manager – Pharmacy Benefits

Database Administrator

• Lead client and project engagements to assess requirements and define database design strategies
• Analyze user needs and develop technical specifications ensuring performance, security, and data integrity
• Design, develop, implement, and maintain database solutions, including automation of data processes and reporting capabilities
• Monitor and optimize database performance, manage production support activities (e.g., backup/recovery, archiving), and implement standards
• Drive continuous improvement by maintaining documentation, evaluating emerging technologies, and providing guidance to junior team members

Experienced Database Administrator

Business Analyst

• Play a critical part in ensuring Gainwell is meeting our clients’ objectives in important areas
• Under minimal direction, formulate and define system scope and objectives based on both user needs and a good understanding of information technology, business processes, and industry requirements
• Act as a liaison between client and technical solutions/support groups, using advanced communication skills to elicit, document, analyze and validate client requirements
• Apply extensive knowledge of the client’s business and industry to develop requirements specifications
• Document requirements and translate into proper system requirements specifications using high-maturity methods, processes, and tools
• Develop visualization, user experience and configuration elements of solution design
• Execute and coordinate requirements management and change management processes
• Develop and maintain internal and external relationships to support management of scope and expectations
• Participate in proposals, feasibility studies, implementations, and new business development
• Operates as a team member and as a team leader
• Advise on methods to improve business processes

• Play a key role in delivering high-quality business analysis support across projects, contributing to the success of system implementations and enhancements.
• Develop and own structured solution artifacts that define discrete system changes or work products, driving them end-to-end from initial definition through stakeholder review, build coordination, testing alignment, implementation, and closure.
• Elicit, document, and manage business, functional, and non-functional requirements, translating business needs into clear, actionable deliverables for technical and project teams.
• Support development of project deliverables, including requirements, design documentation, and user-facing materials.
• Analyze business processes and system impacts across functional areas, identifying opportunities to improve efficiency, accuracy, and alignment with project objectives.
• Participate in and support requirements workshops, design sessions, and client walkthroughs.
• Ensure adherence to established standards, templates, and naming conventions across deliverables.
• Maintain project coordination and communication activities, including capturing and distributing meeting minutes, tracking status of work items, and providing regular updates to Project Managers, Business Leads, and other stakeholders.
• Provide guidance and support to junior BAs, contributing to team consistency and development.

Senior Business Analyst

• support complex healthcare IT initiatives by translating business needs into well-defined, high-quality system solutions
• contribute to requirements, design, and testing activities while partnering with project teams
• ensure solutions are complete, accurate, and aligned with client expectations
• work closely with project leadership, technical teams, and client stakeholders to deliver outcomes that improve care delivery and operational effectiveness for Wisconsin Department of Health Services, Medicaid members, and providers
• develop and own structured solution artifacts that define discrete system changes or work products
• elicit, document, and manage business, functional, and non-functional requirements
• analyze business processes and system impacts across functional areas
• participate in and support requirements workshops, design sessions, and client walkthroughs
• maintain project coordination and communication activities

• Lead business analysis efforts for complex, high-impact healthcare initiatives
• Serve as the Project Business Lead for the Pharmacy F6 / NCPDP upgrade
• Partner with project leadership and client stakeholders to translate business needs into high-quality system solutions
• Coordinate with the Test Lead and testing team to ensure alignment of test scenarios and test cases

Experienced Business Analyst – Project Business Lead, Pharmacy F6, NCPDP Upgrade

• Participation and representation in a client facing Data Governance Committee, including making recommendations, guiding decisions and recommendations within the scope of Client, State and Federal data governance policies, practices, and standards relevant to data management
• Ensure and maintain to the highest standards the quality and security of data within program engagement through adherence to processes and procedures for access controls and monitoring of data activities and use to protect data integrity, including ensuring compliance for the preservation and protection of Protected Health Information (PHI) and Protected Identification Information (PII)
• Collaborate with stakeholders in the design, testing, implementation and ongoing maintenance and support activities of data services
• Assist the Client in solving data-related issues by managing data corruption or mapping data between program areas
• Maintain internally established data quality reporting metrics, evaluate, and identify issues/corrections and coordinate and implement data management best practices
• Identify data assets, lineage, and business rules within data domains to ensure data element continuity and avoid data conflict
• Manage data design, creation and management of database architecture and data repositories
• Maintain accurate and current content within the data management plan including all diagrams, workflows, and all other data related documentation
• Conduct and comply with data reviews and auditing to ensure adherence to current standards, policies and design of the database architecture and repositories
• Ensure documentation and processes are followed, including Architectural Board approvals and other necessary approvals, for all data architecture changes

Pharmacy Account Director

Product Developer

Data Engineer

Application Architect

Principal, Data Sciences

Senior Drug Rebate Analyst

Medical Claims Resolution Analyst

Pre-Payment Review Nurse Consultant

Program Manager – Pharmacy Benefits

Experienced Database Administrator

Business Analyst

Senior Business Analyst

Senior Business Analyst

Experienced Business Analyst – Project Business Lead, Pharmacy F6, NCPDP Upgrade

Data Architect