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Business Process Analysis SME, Medicaid Domain, C/Pro*C Programming
Gainwell Technologies. Analyze Federal and State Medicaid policy requirements .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Medicaid policy analysis and Business Policy Administration (BPA) with a strong focus on rule specifications, impact analysis, and compliance verification. Proficient in collaborating with cross-functional teams to design and maintain effective BPA rule solutions.
Highest-signal resume keywords
BPA Subject Matter ExpertMedicaid Claims ProcessingSQLBusiness Rule DocumentationImpact Analysis
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
BPA Rule AnalysisRequirements GatheringData MappingQuery AnalysisBenefit Plan AnalysisProvider Contract AnalysisC ProgrammingPro*CUnix/LinuxBusiness Rules Editor
Tools & Technologies
MS MES Business Policy AdministrationOracleRule SheetsRule MetadataRule Variables
Industry Keywords
Medicaid Policy InterpretationClaims Adjudication KnowledgeProvider Enrollment & MaintenanceBenefit ClassificationsRule Configuration Lifecycle
Tech Stack
Tools & technologiesLinuxOracleSQLUnix
About the role
Key responsibilities & impact- Analyze Federal and State Medicaid policy requirements
- Translate policy requirements into BPA rule specifications
- Create decision tables, rule mapping documents, and business rule specifications
- Analyze and support Benefit Plans, Assignment Plans, Provider Contracts, Reimbursement Rules, Copay Rules, Audit Rules, and Form Edit Rules
- Understand how BPA impacts claim adjudication
- Analyze coverage determination, provider eligibility validations, provider contract validations, and reimbursement processing
- Review and validate BPA Rule Sheets
- Support the BPA Rule Sheet release management process
- Review approvals and configuration promotions
- Perform rule impact analysis
- Validate overlapping rule scenarios
- Support BPA Rule Sheet governance
- Create acceptance criteria
- Develop BPA test scenarios
- Perform policy compliance verification
- Collaborate with Business Analysts, DOM SMEs, Operations, Reference teams, Developers, and Testing teams to design, configure, validate, and maintain BPA rule solutions
Requirements
What you’ll need- Experienced BPA SME with Medicaid domain expertise
- Strong understanding of MS MES Business Policy Administration
- Experience with Medicaid Claims Processing
- Experience with Medicaid Policy Interpretation
- Benefit Plan Analysis
- Assignment Plan Analysis
- Provider Contract Analysis
- BPA Rule Analysis
- Requirements Gathering
- Impact Analysis
- Business Rule Documentation
- SQL
- Oracle
- Working knowledge of C Programming
- Working knowledge of Pro*C
- Unix/Linux
- Data Mapping
- Query Analysis
- Business Rules Editor (BRE)
- Rule Sheets
- Benefit Classifications
- Rule Metadata
- Rule Variables
- Benefit Plan Hierarchies
- Provider Contracts
- Rule Configuration Lifecycle
- MES/MESA Experience preferred
- Medicaid Enterprise Systems preferred
- Claims Adjudication Knowledge preferred
- Provider Enrollment & Maintenance preferred
- Reference Data Knowledge preferred
- Rule Engine Experience preferred
Benefits
Comp & perks- 🌐 Worldwide ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs ✉️ Email Alerts 👤 Account Gainwell Technologies Website LinkedIn All 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. Business Process Analysis SME, Medicaid Domain, C/Pro*C Programming Job not on LinkedIn 🔥 0 minutes ago 🇮🇳 India – Remote ⏰ Full Time 🟡 Mid-level 🟠 Senior ⚙️ Business Operations 👻 Ghost score 10% Apply Now Customize resume + cover letter Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 Description
- Analyze Federal and State Medicaid policy requirements
- Translate policy requirements into BPA rule specifications
- Create decision tables, rule mapping documents, and business rule specifications
- Analyze and support Benefit Plans, Assignment Plans, Provider Contracts, Reimbursement Rules, Copay Rules, Audit Rules, and Form Edit Rules
- Understand how BPA impacts claim adjudication
- Analyze coverage determination, provider eligibility validations, provider contract validations, and reimbursement processing
- Review and validate BPA Rule Sheets
- Support the BPA Rule Sheet release management process
- Review approvals and configuration promotions
- Perform rule impact analysis
- Validate overlapping rule scenarios
- Support BPA Rule Sheet governance
- Create acceptance criteria
- Develop BPA test scenarios
- Perform policy compliance verification
- Collaborate with Business Analysts, DOM SMEs, Operations, Reference teams, Developers, and Testing teams to design, configure, validate, and maintain BPA rule solutions 🎯 Requirements
- Experienced BPA SME with Medicaid domain expertise
- Strong understanding of MS MES Business Policy Administration
- Experience with Medicaid Claims Processing
- Experience with Medicaid Policy Interpretation
- Benefit Plan Analysis
- Assignment Plan Analysis
- Provider Contract Analysis
- BPA Rule Analysis
- Requirements Gathering
- Impact Analysis
- Business Rule Documentation
- SQL
- Oracle
- Working knowledge of C Programming
- Working knowledge of Pro*C
- Unix/Linux
- Data Mapping
- Query Analysis
- Business Rules Editor (BRE)
- Rule Sheets
- Benefit Classifications
- Rule Metadata
- Rule Variables
- Benefit Plan Hierarchies
- Provider Contracts
- Rule Configuration Lifecycle
- MES/MESA Experience preferred
- Medicaid Enterprise Systems preferred
- Claims Adjudication Knowledge preferred
- Provider Enrollment & Maintenance preferred
- Reference Data Knowledge preferred
- Rule Engine Experience preferred Apply Now 📊 Check your resume score for this job Improve your chances of getting an interview by checking your resume score before you apply. Check Resume Score Similar Jobs Business Operations – Strategy Manager 🕒 August 25 Group 1001 501 - 1000 💼 Consulting 🏥 Healthcare 💸 Finance Website LinkedIn All Job Openings Business Operations Manager scaling Gainbridge’s digital financial-products platform. Building planning, governance, vendor, compliance, and cross-functional execution systems. 🇮🇳 India – Remote ⏰ Full Time 🟡 Mid-level 🟠 Senior ⚙️ Business Operations Business Analyst, Operations 🕒 August 25 Red Nucleus 501 - 1000 🏥 Healthcare 💼 Consulting 🏭 Manufacturing Website LinkedIn All Job Openings Business Analyst improving enterprise delivery operations, resource planning, governance, and reporting. Supporting Red Nucleus’s life sciences learning, advisory, and medical communications services. 🇮🇳 India – Remote ⏰ Full Time 🟡 Mid-level 🟠 Senior ⚙️ Business Operations Project Manager/Business Operations Manager 🕒 August 17 Marrina Decisions 11 - 50 🤝 B2B 📣 Marketing Website LinkedIn All Job Openings Project Manager overseeing marketing operations, performance campaigns, and creative workflows for a marketing consultancy in India. Managing timelines, reporting, automation, and cross-functional teams. 🇮🇳 India – Remote ⏰ Full Time 🟠 Senior 🔴 Lead ⚙️ Business Operations Business Operations Analyst 🕒 August 17 Akamai Technologies 5001 - 10000 🔒 Cybersecurity 🏢 Enterprise 📱 Media Website LinkedIn All Job Openings Business Operations Analyst supporting Akamai’s global operations teams in India. Managing forecasts, budgets, purchase orders, invoicing, accruals, vendors, and lease invoices. 🇮🇳 India – Remote ⏰ Full Time 🟡 Mid-level 🟠 Senior ⚙️ Business Operations Lead – Business Operations & Strategy 🕒 July 9 BrowserStack 501 - 1000 ☁️ SaaS Website LinkedIn All Job Openings Business strategy and operations lead shaping marketing and GTM growth at BrowserStack. Driving research, competitive intelligence, CRM data quality, and executive insights. 🇮🇳 India – Remote 💰 $2G Series B on 2021-06 ⏰ Full Time 🟠 Senior ⚙️ Business Operations View More Business Operations Jobs 🌐 Worldwide Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com Search Remote jobs Search Jobs by country Search jobs by city Search jobs by job title Search entry-level jobs Search junior-level jobs Search senior-level jobs Search jobs by tech stack Search jobs by contract type Search remote internships Search remote part-time jobs Remote jobs Anywhere in the World Companies Hiring Anywhere in the World Companies Hiring Sales People Anywhere in the World Companies Hiring Software Engineers Anywhere in the World Resources About us Advice Tips for finding remote jobs Interview questions and answers Resume examples Cover letter examples Post a job Affiliates Is Remote Rocketship legit? Privacy policy Terms of service Job board SEO course Remote Job Search MasterClass Resume Review AI Apply Copilot OpenClaw job finder API docs Find jobs using your resume Jobs by Country Remote jobs anywhere in the world (Worldwide remote jobs) Remote jobs United States Remote jobs Australia Remote jobs Brazil Remote jobs Canada Remote jobs France Remote jobs Ireland Remote jobs Germany Remote jobs Netherlands Remote jobs Spain Remote jobs UK Popular Jobs Remote data analyst jobs Remote customer support jobs Remote executive assistant jobs Remote marketing jobs Remote product designer jobs Remote product manager jobs Remote project manager jobs Remote recruiter jobs Remote sales jobs Remote software engineer jobs Jobs by Type Remote full-time jobs Remote part-time jobs Remote contract jobs Remote internship jobs Remote entry-level jobs Remote jobs with no experience required Remote junior jobs (1-3 years of experience) Digital nomad jobs Remote jobs with no degree required Freelance remote jobs Temporary remote jobs Remote jobs hiring now Stay at home mom jobs