Experienced Claims Business Analyst

🔥 7 minutes ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $86.8k - $124k / year

⏰ Full Time

🟠 Senior

🔴 Lead

🧐 Business Analyst

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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

• Analyze claims data to identify denial trends and operational bottlenecks • Perform in-depth investigation of complex claims issues, determining root causes • Provide actionable recommendations to support issue resolution, enhancements, and system improvements • Collaborate with cross-functional teams to reconcile claims outcomes • Develop reporting, dashboards, and monitoring tools for 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 • Proven ability to solve complex issues and translate technical findings into business insights • Strong communication and collaboration skills; experience in Medicaid or Medicare environments preferred

🏖️ Benefits

• Health benefits • 401(k) employer match • Flexible vacation policy • Educational assistance • Leadership and technical development academies