Advisor, Claims Business Analyst

🔥 0 minutes ago

🎰 Nevada, New York – Remote

🎰 Nevada – Remote 🗽 New York – Remote

⏰ Full Time

🟠 Senior

🔴 Lead

🧐 Business Analyst

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

Apply Now

Find Similar Remote Jobs

Receive Emails For Remote Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Healthcare Insurance • Human Services • Healthcare

Gainwell Technologies is the nation’s leading provider of digital and cloud-enabled solutions across the human services and public health ecosystem. With a mission-driven approach, Gainwell serves clients in all 50 U. S. states, focusing on improving health outcomes and delivering intuitive, human-centered experiences. Their comprehensive suite of solutions includes Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions, all designed to advance the future of healthcare and enhance community well-being.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

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