Senior Business Analyst – Claims Configuration

🕒 September 16

🇺🇸 United States – Remote

💵 $92.9k - $132.7k / year

⏰ Full Time

🟠 Senior

🧐 Business Analyst

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New 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

💼 Consulting

📦 Logistics

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Consulting • Logistics • Healthcare Insurance

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

• Lead, mentor, and provide day-to-day technical direction to Claims Configuration Business Analysts • Serve as senior configuration subject matter expert and trusted advisor for assigned CEF Claims M&O accounts • Review configuration analysis, solution designs, implementation plans, and validation results • Establish configuration practices, documentation standards, peer-review controls, and knowledge-transfer processes • Interact with clients, vendors, and internal business, product, development, testing, operations, finance, provider, member, and encounter teams • Lead requirements discussions, configuration reviews, issue-resolution sessions, defect triage, solution walkthroughs, and operational governance discussions • Translate technical findings into business impacts, options, risks, and recommendations • Own issues and enhancements from intake and analysis through implementation, validation, communication, and closure • Configure and support QNXT claims solutions across contracts, benefits, fee schedules, payment methodologies, capitation, business rules, claims adjudication logic, X12 transaction data requirements, and CARC/RARC processing • Translate Medicaid policy, contractual requirements, and operational needs into configuration specifications, business rules, design artifacts, and acceptance criteria • Assess impacts across claims adjudication, pricing, benefits, provider reimbursement, encounters, remittance, financial processing, reporting, and downstream integrations • Determine root causes across configuration, data, policy interpretation, user processing, interfaces, product functionality, and dependencies • Write and execute complex SQL queries to analyze claims and related healthcare data • Trace system behavior using relational database schemas and data relationships • Perform claim-level and population-level root cause analysis for processing anomalies • Quantify impacted claims and populations, document evidence, compare expected and actual results, and recommend corrective actions • Support production incidents, client inquiries, audit requests, configuration defects, data fixes, and ad hoc reporting • Validate configuration changes through data analysis, claims testing, regression review, and post-implementation monitoring • Coordinate production support, priority issue resolution, scheduled releases, and multiple client and internal teams

🎯 Requirements

• 9+ years of hands-on, highly proficient QNXT configuration experience • Demonstrated depth in contracts, benefits, fee schedules, multiple payment methodologies, capitation, rules, X12 transaction data requirements, and CARC/RARC processing • Thorough understanding of relational database concepts, healthcare data models, schemas, keys, and data relationships • Competency writing complex SQL queries for claims analysis, validation, troubleshooting, root cause analysis, and reporting • Strong experience with Medicaid claims processing, claims adjudication, provider reimbursement, benefits, and encounter processing • Experience analyzing healthcare transactions (837/835), claims data, and remittance information • Ability to troubleshoot complex claims issues, identify root causes, and implement effective solutions • Experience leading or mentoring analysts and collaborating with clients, stakeholders, and cross-functional teams • Knowledge of Agile/SDLC environments and healthcare industry regulations, policies, and compliance requirements

🏖️ Benefits

• Work flexibility • Learning and career development • Flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies • Video cameras used during interviews and initial week of orientation