Advisor, Claims Business Analyst

🕒 Junho 5

🎰 Nevada, New York – Remoto

🎰 Nevada – Remote 🗽 New York – Remote

⏰ Tempo Integral

🟠 Sênior

🔴 Especialista

🧐 Analista de Negócios

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Gainwell Technologies

SiteLinkedInTodas as Vagas

10.000+ funcionários

⚕️ Seguro de Saúde

💰 Grant em 2023-06

Healthcare Insurance • Human Services • Healthcare

A Gainwell Technologies é a principal provedora do país de soluções digitais e cloud-enabled em todo o ecossistema de serviços humanos e saúde pública. Com uma abordagem orientada por propósito, a Gainwell atende clientes nos 50 estados dos EUA, com foco em melhorar os desfechos em saúde e oferecer experiências intuitivas e centradas nas pessoas. Seu portfólio abrangente inclui modernização do Medicaid Enterprise, data analytics, serviços para prestadores e soluções para farmácia — tudo projetado para impulsionar o futuro da saúde e promover o bem-estar das comunidades.

Descrição

• Support end-to-end claims workflow analysis, configuration support, and complex issue resolution within the MMIS ecosystem • Provide advanced (L2) support for claims operations by leveraging deep expertise in Medicaid claims adjudication, data analysis, and cross-functional collaboration • Drive root-cause analysis, identify trends, and recommend solutions that improve first-pass rates, reduce denials, and support client and organizational objectives • Analyze claims data to identify denial trends, operational bottlenecks, and opportunities to improve first-pass rates and reduce rework • Perform in-depth investigation of complex claims issues, determining root causes across policy, data, user, or configuration factors • Provide actionable recommendations and detailed documentation to support issue resolution, enhancements, and system improvements • Collaborate with cross-functional teams (e.g., operations, IT, policy, finance) to reconcile claims outcomes and ensure data integrity • Develop reporting, dashboards, and monitoring tools to provide insights and support leadership decision-making

🎯 Requisitos

• 9+ years of experience in claims business analysis, configuration, or healthcare operations • Advanced knowledge of healthcare claims processing, including coding (ICD-10, CPT, modifiers), billing, and adjudication rules • Strong SQL skills and experience analyzing large datasets to identify trends, root causes, and performance improvements • Proven ability to solve complex issues, translate technical findings into business insights, and work within client/vendor environments • Strong communication, collaboration, and stakeholder engagement skills; experience in Medicaid or Medicare environments preferred

🏖️ Benefícios

• Flexible vacation policy • Educational assistance • Comprehensive leadership and technical development academies