Gainwell Technologies

Software Engineer

• Design, develop, maintain, and support complex batch processing applications in Linux and Unix environments
• Provide technical leadership, mentor developers, guide solution design, conduct code reviews, and support all SDLC phases
• Collaborate with business analysts, architects, quality assurance teams, and stakeholders to translate requirements into technical solutions
• Analyze, troubleshoot, and resolve complex application and database issues using SQL Server and/or Oracle
• Perform root cause analysis and implement corrective actions to improve system performance and stability
• Support change management, release planning, production deployments, and continuous improvement initiatives
• Drive modernization through automation, cloud technologies, and DevOps best practices
• Contribute to Medicaid healthcare systems, including claims processing, reference systems, PBM, Drug Rebate, ProdDur, batch processing environments, and other critical healthcare applications
• Develop and maintain technical documentation, process flows, and support materials

Senior Batch Developer – Pharmacy Claims

Supervisor

• Build, develop, and lead teams of individual contributors
• Support employees and execute day-to-day operations
• Establish and lead regular operational routines
• Use tools and reporting to drive team performance
• Train and provide ongoing coaching using account-specific metrics, AHT, APT, occupancy, utilization, quality scores, and other performance measures
• Participate in client-related activities, including project planning and client calibration sessions
• Ensure employee adherence to company, client, and regulatory policies
• Work with employees and operational leaders to achieve Client Service Level Agreements (SLAs)
• Serve as a point of escalation
• Handle escalated calls and customer inquiries
• Remove obstacles, champion change, and drive employee awareness and connection to their work

Provider Enrollment Supervisor

Vice President

• Develop high-quality business strategies and operational plans aligned with Gainwell’s short-term and long-term objectives for the solution offering
• Oversee payment integrity delivery operations to drive revenue growth, margin expansion, and client satisfaction
• Lead and motivate team members, develop a high-performing managerial team, and partner cross-functionally with Finance, Account Management, Sales, Engineering, and Implementations
• Manage pre-payment and post-payment payment integrity solutions, including Clinical Claim Reviews, Payment Analytics/Data Mining, FraudCapture, Utilization Review, Long-Term Care, and Credit Balance
• Develop, manage, and attain revenue and expense budget goals
• Manage product portfolio development plans with technical development partners in alignment with client needs and revenue forecasting
• Monitor systems and processes that identify and mitigate payment integrity revenue portfolio opportunities and risks
• Apply advanced financial analysis and forecasting techniques to project and optimize revenue
• Collaborate with the VP Product on product expansion and annual revenue targets
• Partner with the AI development team on projects improving efficiency, accelerating growth, and speeding go-to-market solutions
• Represent the company in pre-sales solutioning efforts and collaboratively design solutions with Gainwell SGMs and HMS SVP Client Management
• Partner with clinical operations on demand, capacity, and compliance with client SLAs and contract requirements
• Oversee RFP and new business proposal reviews for strategic fit and implementation, operational, and financial success
• Improve product quality through defect identification, root cause analysis, and corrective action project management
• Improve internal product processes through Lean and AI-driven continuous quality improvement methodologies
• Manage staffing planning and workforce management tools across the delivery team
• Build operational metrics covering service efficiency, quality, cost per unit, productivity, staffing to demand, appeals, and analytics efficacy
• Coordinate with the product implementation team on solution architecture and end-to-end project management of new implementations
• Communicate product strategy, financial results, operational status, and quality/compliance issues to company leadership
• Lead delivery teams through regular communication, recognition, and quarterly Town Hall meetings
• Direct leadership development and training, including bench strength and succession planning
• Participate in talent and succession management review sessions as a Talent Management champion

Vice President, Payment Integrity

Reviewer

• Review and analyze complex medical, psychological, developmental, and functional information for children applying for or participating in Wisconsin’s Katie Beckett Medicaid program
• Develop disability determination recommendations using medical evidence, functional limitations, Social Security Act requirements and disability criteria, policies, regulations, procedures, and quality standards
• Evaluate medical terminology, disease processes, diagnostic testing, treatment practices, physical and mental impairments, and other relevant evidence
• Identify when additional medical information is necessary to complete a review
• Prepare electronic case documentation, written review requests, case summaries, determination records, and required notifications
• Maintain confidentiality and comply with applicable regulations and program requirements
• Independently manage an assigned disability caseload
• Collaborate with reviewers, clinical consultants, supervisors, and operational partners to research discrepancies, resolve complex cases, and reach logical and objective conclusions
• Travel quarterly to Madison, Wisconsin for meetings or other business needs

Disability Reviewer

Backend Engineer

• Design, develop, install, test, and document application software, including server, client, and web components
• Design, document, and deliver technical architecture solution elements
• Coordinate between application architects and developers to ensure accurate design requirements and desired client ROI
• Define and develop project requirements, functional specifications, and detailed application solution designs for clients
• Develop technical documentation and test plans to support integration and deployment
• Work closely with software developers to advance goals and objectives for Gainwell and its clients
• Support clients in delivering better health and human services outcomes

Application Developer, C#, .Net, Razor Pages

Representative

• Build and maintain strong working relationships with healthcare providers and provider organizations throughout an assigned Southern California territory
• Conduct virtual and onsite provider visits to provide education, training, operational support, and assistance with Medi-Cal program requirements
• Develop and deliver provider training through workshops, seminars, webinars, one-on-one sessions, and other virtual and in-person educational events
• Provide one-on-one billing support and research healthcare claims, payment, and provider-related issues
• Serve as a liaison between healthcare providers, provider associations, internal Gainwell departments, and client representatives
• Apply established Medi-Cal policies, procedures, and program requirements to research and resolve provider questions and operational issues
• Identify provider trends, recurring issues, and opportunities for additional education or process improvement and communicate findings to leadership
• Exercise independent judgment within established guidelines while escalating complex or sensitive issues as appropriate
• Work from home when not conducting provider visits, training sessions, meetings, or other field activities
• Regularly travel throughout the assigned Southern California territory and interact with healthcare providers, client representatives, and internal Gainwell teams

Provider Field Representative

• Build and maintain strong working relationships with healthcare providers and provider organizations throughout an assigned Central California territory
• Conduct virtual and onsite provider visits to provide education, training, operational support, and assistance with Medi-Cal program requirements
• Develop and deliver provider training through workshops, seminars, webinars, one-on-one sessions, and other virtual and in-person educational events
• Provide one-on-one billing support and research healthcare claims, payment, and provider-related issues
• Serve as a liaison between healthcare providers, provider associations, internal Gainwell departments, and client representatives
• Apply established Medi-Cal policies, procedures, and program requirements to research and resolve provider questions and operational issues
• Identify provider trends, recurring issues, and opportunities for additional education or process improvement and communicate findings to leadership
• Exercise independent judgment within established guidelines while escalating complex or sensitive issues as appropriate
• Travel throughout the assigned Central California territory for provider visits, training, outreach activities, provider association events, and other business needs
• Work from home when not conducting provider visits, training sessions, meetings, or other field activities

• Build and maintain relationships with healthcare providers and provider organizations throughout an assigned Northern California territory
• Conduct virtual and onsite provider visits to provide education, training, operational support, and assistance with Medi-Cal program requirements
• Develop and deliver provider training through workshops, seminars, webinars, one-on-one sessions, and other virtual and in-person educational events
• Provide one-on-one billing support and research healthcare claims, payment, and provider-related issues
• Serve as a liaison between healthcare providers, provider associations, internal Gainwell departments, and client representatives
• Apply Medi-Cal policies, procedures, and program requirements to research and resolve provider questions and operational issues
• Identify provider trends, recurring issues, and opportunities for education or process improvement and communicate findings to leadership
• Exercise independent judgment within established guidelines and escalate complex or sensitive issues as appropriate
• Travel throughout the assigned Northern California territory for provider visits, training, outreach activities, provider association events, and other business needs
• Represent Gainwell professionally during provider meetings, training sessions, and outreach activities

Operations

• Provide strategic oversight and guidance on system operations, ensuring reliability, scalability, and performance across platforms
• Partner with leadership and technical teams to identify operational challenges and implement solutions that improve efficiency and service delivery
• Analyze operational metrics, system performance, and trends to provide actionable insights and recommendations
• Support resolution of complex system issues and escalations, ensuring minimal disruption to business operations
• Drive continuous improvement initiatives, including process optimization, automation, and operational best practices
• Own strategic system operations initiatives and performance improvements
• Collaborate with technical teams, leadership, and cross-functional stakeholders
• Drive system reliability, efficiency, and continuous operational improvement

System Operations Manager

Call Center Representative

• Provide knowledgeable responses to basic client questions and escalate complex cases to appropriate staff
• Solve client problems, update account history, and follow up with clients to confirm resolution
• Adhere to client SLAs and consistently meet production targets
• Collaborate with team members, management, and clients to resolve inquiries
• Cross-train new resources in customer service processes
• Review and recommend changes to procedures and workflow to improve inquiry processing efficiency

Bilingual Call Center Agent

Architect

• Code highly complex programs and derive logical processes on technical platforms to support business processes and initiatives
• Design user system interfaces and business application prototypes
• Engage in performance and integration testing, business and technical analysis, and data modeling
• Build high-complexity screens, windows, and reports
• Serve as a technical expert for clients and eliminate gaps and inconsistencies in information system architectures
• Establish principles, directions, and standards for the information system framework at the program/project level
• Define information system solution components and their relationships
• Ensure information solutions support incremental development, maintenance, and future enhancements
• Oversee and facilitate cross-functional teams working in parallel on architecture needs
• Provide guidance and oversight in developing internal information solution architecture
• Research technological advancements and update standards to improve company solutions
• Identify business requirements and ensure solutions meet performance engineering expectations
• Reduce client risks by ensuring adherence to architectural requirements within price, scope, and time constraints

Principal Application Architect

Learning and Development

• Deliver engaging and interactive training sessions to new and existing call center agents and general training for other departments such as field services teams
• Facilitate virtual training programs to enhance employee skills and performance
• Adapt training delivery to various learning styles and needs
• Design visually engaging and interactive training material and presentations using modern adult learning principles and varied learning needs
• Collaborate with the LKI training team, SMEs, and account leaders to ensure training materials are effective and user-friendly
• Provide post-training support and resources to learners and call center leadership
• Assess training outcomes through surveys, feedback, and performance metrics

Training Specialist

Pharmacist

• Oversee pharmacy operations teams, including drug rebate invoicing, collections, claims review, grievance and appeals, and related functions
• Monitor KPIs, SLAs, productivity metrics, and staffing levels to meet contractual obligations
• Lead process improvement and efficiency initiatives
• Hire, onboard, and train new pharmacy operations staff
• Review and provide feedback on monthly and quarterly operations reports
• Manage staff productivity and performance, including performance reviews and evaluations
• Monitor staff attendance and timekeeping for accuracy and policy compliance
• Coach staff and support skills development and professional growth
• Ensure monthly and quarterly SLAs are accurate and completed on time
• Keep pharmacy service policies and procedures up to date
• Work with the account PBM Manager to update staff performance metrics
• Prepare and maintain operations documentation
• Develop management and client reports
• Liaise with subject matter experts on industry best practices, process improvement, and customer service
• Interact with internal and external stakeholders to achieve operations goals
• Participate in project work-plan tasks and ensure compliance with audit control objectives
• Lead or assist with special projects and ad hoc client requests
• Foster a positive team environment and lead by example

Senior Manager, Pharmacy and Drug Rebate Services

Director

• Conduct Medicaid federal, market, policy, and competitor analysis to inform product strategy and innovation roadmaps
• Analyze target markets, competitive landscapes, portfolio positioning, and federal CMS and state mandates
• Develop business cases for new solutions that create value for Gainwell and its clients
• Interface with engineering and business leads to identify and prioritize technology advancement opportunities
• Align with the Provider Solutions team to evolve existing solutions through organic and inorganic transformation
• Coordinate strategy, work, and communication across Product, Engineering, Implementation, Delivery/Operations, Marketing, and Sales leadership
• Produce and deliver executive reports on technology and innovation vision, strategy, and finances
• Oversee technology and product advancements from concept through delivery across the Provider portfolio
• Report directly to the Senior Vice President and General Manager of Provider Solutions

Director, Provider Technology and Innovation Strategy

Business Analyst

• Apply intermediate subject matter knowledge to solve common business issues
• Analyze business goals, objectives and needs for multiple accounts
• Align information technology solutions with business initiatives
• Serve as liaison between technical personnel and business areas
• Plan and design business processes
• Formulate recommendations to improve and support business activities
• Analyze and document client business requirements and processes
• Construct conceptual data and process models, data dictionaries and volume estimates
• Create basic test scenarios and execute systems tests
• Develop and modify systems requirements documentation
• Participate in client meetings to gather requirements and explore solutions
• Analyze test results and participate in technical reviews and inspections
• Develop structured user manuals and training materials
• Perform business rules modeling and develop and execute acceptance test plans

Senior Batch Developer – Pharmacy Claims

Provider Enrollment Supervisor

Vice President, Payment Integrity

Disability Reviewer

Application Developer, C#, .Net, Razor Pages

Provider Field Representative

Provider Field Representative

Provider Field Representative

System Operations Manager

Bilingual Call Center Agent

Principal Application Architect

Training Specialist

Senior Manager, Pharmacy and Drug Rebate Services

Director, Provider Technology and Innovation Strategy

Application Business Analyst