Gainwell Technologies

Representative

• Provide functional leadership and direction to Provider Field Representatives serving California’s Medi-Cal provider community
• Support team escalations, complex provider inquiries, billing questions, claims issues, and program requirements
• Provide one-on-one billing assistance, claims research and analysis, reimbursement support, and resolution of provider billing issues
• Support and help direct provider education and outreach, including workshops, seminars, program-specific events, one-on-one training, and provider association activities
• Serve as a liaison between providers, internal departments, and the client to resolve issues and support Medi-Cal programs and initiatives
• Apply policies and procedures while exercising independent judgment to resolve complex provider issues and recommend solutions or escalation
• Contribute to shared knowledge resources and document complex issue resolution
• Support development and mentoring of Provider Field Representatives
• Identify opportunities to improve provider service, team processes, and operational effectiveness
• Travel throughout California for provider training, outreach, events, and other business needs

Provider Field Representative Lead

AI Engineer

• Design, build, and train machine learning and deep learning models, including GenAI, NLP, and predictive analytics solutions for healthcare applications
• Develop, test, and deploy AI solutions in cloud and on-premise environments
• Work with large healthcare datasets, performing data preprocessing, feature engineering, and model training while ensuring HIPAA and regulatory compliance
• Implement and optimize AI models within Gainwell’s existing technology stack
• Collaborate with software engineers to ensure seamless system integration
• Monitor, refine, and optimize AI models for accuracy, efficiency, and speed using MLOps best practices
• Stay updated with AI/ML advancements and explore new technologies and methodologies
• Ensure AI implementations adhere to healthcare regulations, ethical AI principles, and data privacy standards
• Identify opportunities to automate workflows and optimize business processes using AI-driven solutions

Principal AI Engineer

Business Analyst

• Serve as the primary liaison between clients, business stakeholders, and internal operational teams
• Gather, analyze, and document client and business requirements
• Translate client needs into functional requirements and actionable work items
• Facilitate communication between business stakeholders and technical teams
• Participate in requirements reviews, solution discussions, and service enhancement planning
• Identify process improvement opportunities and recommend solutions
• Serve as a primary contact for service-related requests and inquiries
• Coordinate service provisioning and support activities across internal teams
• Monitor service requests and ensure timely completion
• Provide status updates and communications to clients and stakeholders
• Escalate issues, risks, and service delivery concerns
• Participate in projects involving new services, enhancements, and operational improvements
• Coordinate service readiness and support implementation efforts
• Assist with project planning, testing, operational impact assessments, and transition-to-support activities
• Create, manage, track, and close service requests, incidents, and work items
• Use ServiceNow to manage incidents, requests, changes, and service fulfillment activities
• Use Azure DevOps to track user stories, defects, tasks, and project work items
• Support ALM processes, requirements tracking, testing coordination, defect management, and release support
• Develop and maintain service procedures, operational documentation, knowledge articles, and reference materials
• Support training and process documentation for internal stakeholders

Business Analyst, Services Coordinator

Manager

• Lead service delivery and operational execution for Medicaid Claims, Business Policy Administration, and Reference Data Maintenance teams
• Manage multiple clients and domain leads responsible for Medicaid claims, business policy administration, reference data maintenance, provider setup, and adjudication logic
• Drive standardization and process improvements across design, build, test, deployment, and operational support
• Develop and manage demand forecasts with account and product teams
• Align capacity with client priorities and identify workload, capacity, and delivery timeline risks
• Lead relationships between delivery teams, product engineering, and client stakeholders
• Resolve escalations and ensure timely issue resolution
• Drive continuous service improvements focused on claims accuracy, policy administration quality, reference data integrity, defect reduction, and turnaround times
• Ensure delivery outcomes meet client expectations for quality, compliance, and timeliness
• Select and hire employees with relevant domain expertise
• Coach and develop team members
• Address performance issues and drive accountability for results

Senior Manager, Service Delivery

Call Center Representative

• Handle inbound and/or outbound calls related to healthcare services, Medicaid, eligibility, claims, billing, and provider inquiries
• Assess customer needs and resolve questions or concerns during the first interaction whenever possible
• Research inquiries using job aids, knowledge bases, contact center platforms, and other system tools
• Escalate complex or unresolved issues through established escalation paths
• Document customer interactions completely and accurately in required systems
• Meet productivity and quality standards, including Average Handle Time, Quality Assurance scores, and schedule adherence
• Identify recurring customer concerns, trends, and themes and communicate them to appropriate team members
• Follow HIPAA, data privacy, security, and confidentiality requirements when handling protected or sensitive information
• Collaborate with peers, supervisors, and team leads to resolve customer inquiries and support operational objectives
• Participate in cross-training, knowledge-sharing activities, and other auxiliary functions as necessary
• Support the Ohio Fiscal Intermediary account on a fully remote schedule, Monday through Friday, 8:00 a.m. to 4:30 p.m. Eastern Time, or as required by business needs

Healthcare Call Center Representative

• Manage and oversee account service delivery team operations
• Ensure Gainwell products and services are delivered according to project schedules
• Develop demand forecasts with account teams
• Assist functional areas or departments in planning and delivering end-to-end services, including workload requirements
• Navigate relationships between delivery and client groups
• Identify service improvements to increase client satisfaction
• Support proposal teams in integrating new, enhanced, and existing service offerings
• Select and hire employees to support the team
• Train employees to improve performance, development, and work products

Service Delivery Manager

Business Intelligence Analyst

• Partner with business leaders and cross-functional teams to define key performance metrics and gather reporting requirements
• Develop scalable reporting and analytics solutions
• Design, build, and maintain dashboards, reports, data pipelines, and analytics infrastructure
• Identify opportunities to improve data quality, efficiency, and reporting capabilities
• Analyze complex data sets using SQL and other analytical tools
• Translate performance trends into insights, recommendations, risks, and opportunities for technical and non-technical stakeholders
• Lead reporting and analytics projects from requirements through implementation
• Ensure deliverables align with contractual requirements, SLAs, performance expectations, and business objectives
• Serve as a trusted analytics partner to leadership
• Support operational, strategic, and transformational initiatives
• Partner with stakeholders to deliver reporting and analytics supporting operational and strategic decision-making
• Work independently while collaborating with leadership and cross-functional teams

Reporting Analyst

Customer Success Manager

• Engage several clients, including a top 10 client
• Manage client contracts and relationships
• Ensure Gainwell operations perform according to contractual commitments
• Generate revenue and upsell new services to existing clients
• Prepare and monitor budgets and revenue expectations for assigned clients
• Develop project approaches and implementation plans with clients
• Oversee development and implementation
• Report progress toward strategic client growth and business goals to client engagement leadership
• Communicate and interface regularly with clients
• Create agendas and provide recaps for client touchpoints
• Direct contract operations to ensure successful service delivery
• Identify and seek new revenue sources
• Build relationships with internal and external staff to meet or exceed client expectations
• Manage client satisfaction
• Support sales opportunities and assist with closing sales, including proposal development
• Monitor state legislative, regulatory, and competitive environments and alert engagement leadership to risks and opportunities
• Support collaboration between the client engagement team, internal departments, and operations staff
• Handle client invoicing and accrual tracking
• Ensure timely delivery of solution files, reports, invoices, and supporting detail

Client Engagement Manager

Architect

• Lead a small team of data analysts or collaborate with other analysts
• Develop program specifications and mapping documents
• Analyze data to understand transformation requirements
• Work with ETL/Reporting/Conversion staff to ensure code meets documented business requirements
• Test interfaces and reports to ensure requirements are met
• Determine best practices and suggest improvements to current practices
• Work with the development lead to assign and complete project tasks on schedule
• Coordinate work assignments for projects with the development lead
• Complete documentation requirements with project management
• Create accurate mapping documents according to the mapping process
• Deliver solutions to ETL/Reporting/Conversion teams for coding
• Support DSD creation and response
• Present analysis and design recommendations to MITA teams, customers, and vendors
• Support ETL/Reporting/Conversion developers based on created mappings
• Coordinate with configuration teams and DBAs to ensure configuration synchronizes with interfaces and mappings
• Refine mapping documents as questions are resolved
• Use SQL, data models, data element dictionaries, and schemas for data and business analysis
• Create unit test cases
• Validate test plan results against detailed design goals
• Update technical specifications and mappings
• Support Unit Testing, System Integration Testing, System Testing, and User Acceptance Testing

Advisor Application Architect

• Lead a small team of data analysts or collaborate with other analysts
• Develop program specifications and mapping documents
• Analyze data to understand transformation requirements
• Work with ETL/Reporting/Conversion staff to ensure code meets documented business requirements
• Test interfaces and reports to ensure requirements are met
• Determine best practices and suggest improvements to current practices
• Coordinate with the development lead to assign and complete project tasks on schedule
• Research and analyze requirements
• Create and design mapping documents
• Present findings to team members, clients, and vendors
• Coordinate work assignments with the development lead
• Complete documentation requirements with project management
• Create accurate mapping documents according to the mapping process
• Support ETL/Reporting/Conversion developers based on created mappings
• Work with configuration teams and DBAs to ensure synchronization of configuration, interfaces, and mappings
• Refine mapping documents as questions are resolved
• Use SQL, data models, data element dictionaries, and schemas for data and business analysis
• Create unit test cases
• Validate test plan results against detailed design goals
• Update technical specifications and mappings
• Support Unit Testing, System Integration Testing, System Testing, and User Acceptance Testing

Supervisor

• Oversee daily quality assurance activities and prioritize team workload
• Ensure consistent delivery of high-quality results meeting organizational and client expectations
• Identify quality trends and analyze performance data
• Implement process improvements that enhance efficiency, accuracy, and service delivery
• Recruit, train, mentor, and evaluate employees
• Foster accountability, collaboration, and continuous learning
• Lead internal audit activities and ensure compliance with quality standards and operational requirements
• Partner with cross-functional stakeholders on process development, technology implementations, testing, and service improvement initiatives
• Monitor and evaluate voice and non-voice interactions, calls, transactions, and related business processes
• Conduct daily reviews and audits for adherence to client, company, and regulatory standards

CX Quality Supervisor

Full-stack Engineer

• Design, build, test, and operate secure, scalable software for Medicaid DDI programs and modernized Provider Plus capabilities
• Use cloud-native engineering and approved AI coding tools while retaining developer ownership for design, security, correctness, testing, and maintainability
• Develop React/TypeScript micro-frontends and .NET 10/C# microservices, serverless services, and contract-first REST APIs
• Build multi-tenant capabilities using tenant isolation, configuration-driven behavior, feature flags, and coordinated API, UX, and schema versioning
• Develop PostgreSQL solutions and AWS workloads using Lambda, API Gateway, S3, SQS, Glue/Spark, MSK/Kafka, and EKS patterns
• Implement REST, event, queue, batch, and managed file-transfer integrations, including SOAP/WCF adapters
• Create Terraform and CI/CD assets for automated build, testing, security scanning, deployment, rollback, and environment promotion
• Implement automated tests, observability, secure logging, code review, vulnerability remediation, and production-readiness controls

Senior Full Stack Engineer – .NET, React, Cloud

• Provide senior technical leadership for secure, scalable applications supporting Medicaid DDI and modernized Provider Plus delivery
• Lead application design and implementation standards across React/TypeScript, .NET 10/C#, APIs, data, integrations and AWS workloads
• Review complex designs, code, test evidence and technical specifications
• Resolve defects, performance issues and production risks
• Guide multi-tenant architecture, configuration-driven behavior, feature flags, versioning and compatibility with required legacy interfaces
• Guide PostgreSQL modeling, conversion/reconciliation, REST and event-driven integrations, Glue/Spark batch workloads and Kafka/MSK patterns
• Establish Terraform, CI/CD, automated quality gates, observability, secure logging, vulnerability remediation and release controls
• Mentor engineers and communicate technical decisions, risks, tradeoffs and recommendations across product and DDI teams

Lead Full Stack Engineer, .NET, React, AWS

Support Engineer

• Supervise and support a remote team of pharmacy technician support representatives
• Resolve escalated customer inquiries and provide guidance on complex issues
• Monitor and analyze performance metrics to maintain service excellence and SLA compliance
• Develop and implement training programs
• Collaborate with leadership to refine processes and drive operational improvements
• Oversee workflow operations for accuracy, compliance, and service efficiency
• Coach, train, and develop a high-performing team
• Collaborate with management to achieve strategic goals

Pharmacy Supervisor Technician Support

• Own the target-state and transition architecture for modernized Medicaid DDI and Provider Plus capabilities
• Set architecture direction and AI-enabled engineering guardrails across applications, data, integrations, cloud, security, platform delivery and operations
• Define target, transition and reference architectures, principles, standards, architecture decisions, nonfunctional requirements and exception governance
• Guide React micro-frontends, .NET 10/C# microservices, serverless services, REST APIs, PostgreSQL and event-driven solution patterns
• Own multi-tenant isolation, configuration, feature flags, multi-version support and compatibility strategies for legacy SOAP/WCF interfaces
• Define AWS, data, integration, identity, Terraform/CI/CD, observability, resiliency, disaster recovery and operational architecture
• Lead architecture reviews, threat modeling, technology/vendor evaluation, technical-risk decisions and production-readiness governance
• Align product, engineering, security, data, operations and DDI roadmaps
• Mentor architects and communicate tradeoffs to executives

Provider Field Representative Lead

Principal AI Engineer

Business Analyst, Services Coordinator

Senior Manager, Service Delivery

Healthcare Call Center Representative

Service Delivery Manager

Reporting Analyst

Client Engagement Manager

Advisor Application Architect

Advisor Application Architect

CX Quality Supervisor

Senior Full Stack Engineer – .NET, React, Cloud

Lead Full Stack Engineer, .NET, React, AWS

Pharmacy Supervisor Technician Support

Lead Application Architect – Healthcare Technologies