Gainwell Technologies

Quality Specialist

• Apply quality improvement methodologies and change management principles, including IHI, PDSA, Lean, and Six Sigma
• Support Quality Assurance and Performance Improvement (QAPI) program activities
• Support the annual Quality Plan and Population Health interventions
• Collaborate across departments to align and support Population Health strategies
• Facilitate and monitor cross-functional quality improvement initiatives
• Maintain quality documentation, including policies, procedures, committee minutes, and program materials
• Support compliance activities related to External Quality Review Organization (EQRO) requirements
• Drive measurable outcomes, reduce variation, and improve member health outcomes
• Perform other duties as assigned

Quality Improvement Specialist

Business Analyst

• Develop, maintain, and validate current- and future-state business process models, workflows, process documentation, and supporting materials
• Facilitate workshops and working sessions with stakeholders, subject matter experts, product teams, and project teams
• Gather requirements, document business processes, and assess operational impacts
• Analyze process gaps, dependencies, risks, data touchpoints, and downstream impacts
• Recommend improvements supporting efficient operations and successful implementations
• Review system data, SQL-based extracts, database relationships, and business scenarios for process validation and operational readiness
• Align process documentation, training content, and readiness materials with approved requirements and solution design
• Collaborate on implementation planning, stakeholder engagement, communications, user readiness, and adoption of new processes
• Manage assigned work independently, communicate project status and risks, and deliver within established timelines
• Translate processes, requirements, system functionality, and procedures into training and readiness materials
• Develop and maintain job aids, training guides, process maps, workflow documentation, SOPs, and enablement resources
• Document role-based workflows, user access considerations, security impacts, and training requirements
• Review deliverables for clarity, consistency, traceability, accuracy, and compliance with standards
• Contribute to templates, standards, reusable assets, lessons learned, and knowledge repositories
• Provide guidance, peer review, and knowledge sharing to less experienced analysts, modelers, and training resources
• Perform other duties as assigned

Senior Business Analyst – BPM, Training, LMS

• Own governance and validation of AI-generated requirements in Gherkin format
• Align requirements with business rules and data mappings
• Ensure AI-driven test validation and traceability through structured SME review
• Coordinate a business analyst team’s duties and activities on IT projects
• Provide guidance and support to newer team members
• Bridge clients, project managers, and technical staff to define, document, and share business requirements and expected impact
• Develop business specifications with clients at the start of technical projects
• Analyze, plan, design, and document business processes
• Recommend improvements supporting clients’ technology goals
• Verify requirements have been met by approving and validating test results
• Use Excel and SQL to quantify anticipated work impact

Experienced Business Analyst – AI Driven Delivery

• Serve as a key partner to ITO Delivery leadership, supporting strategic initiatives, operational excellence, and business outcomes
• Develop data-driven insights through analytics, dashboards, and KPI measurement for executive decision-making and continuous improvement
• Collaborate with business analysts to make client recommendations that improve business processes
• Translate client business needs and technical requirements into simpler non-technical language
• Analyze and document systems requirements and business processes
• Build basic conceptual data and process models to quantify potential system-change impacts
• Execute and analyze basic test-case scenarios from existing test plans
• Participate in technical reviews and inspections with senior leaders
• Develop Power BI reports and data visualizations
• Support ServiceNow and Azure DevOps intake and workflow optimization
• Create executive presentations and communications
• Manage leadership staff meetings and action tracking
• Coordinate strategic planning sessions and offsite workshops
• Support PI supply and demand forecasting
• Manage CTO/ITO business requests, including status reporting, accomplishments, goals, objectives, and budget-related activities
• Provide actionable insights through data analytics and KPI reporting
• Improve operational efficiency through process automation and workflow optimization
• Coordinate leadership operating rhythms, workshops, and planning events
• Identify improvement opportunities and drive them to completion
• Leverage AI and analytics to accelerate delivery, improve productivity, and enhance business outcomes

Early Career Business Analyst – Strategic Operations

• Lead analysis, design, documentation, and optimization of business processes
• Facilitate stakeholder workshops and client meetings to gather, validate, and document requirements
• Identify gaps and recommend effective solutions
• Develop and maintain BPMN 2.0 business process models, workflows, use cases, and supporting documentation
• Ensure requirements, design artifacts, and project documentation align with business needs and stakeholder expectations
• Lead business analysis activities across multiple projects and mentor junior team members
• Develop project estimates and support planning for business analysis, process modeling, and training activities
• Partner with business, operational, technical, clinical, and vendor stakeholders to evaluate impacts and define business rules
• Maintain documentation standards, perform quality reviews, and manage publication of process models and knowledge assets
• Assess training needs and oversee training programs, eLearning content, job aids, procedures, and operational readiness materials
• Support LMS administration, including learning paths, training surveys, content deployment, and instructor-led training coordination
• Apply Medicaid pharmacy and care management expertise to workflows involving utilization management, prior authorization, appeals, formularies, drug utilization review, clinical edits, member lock-in programs, and care coordination
• Collaborate with pharmacists, clinicians, care management, policy, operations, product, configuration, and technical teams
• Translate pharmacy policies, clinical criteria, system configurations, and operational procedures into requirements, process models, training materials, user guides, and job aids
• Develop scenario-based training, demonstrations, and validation materials for pharmacy and care management users

Experienced Business Analyst – BPM, Training Lead

Pharmacist

• Lead the strategy, planning, governance, and execution of end-to-end pharmacy testing across Medicaid PBM implementations and production enhancements
• Establish testing standards, methodologies, tools, and quality frameworks for SIT, UAT, regression testing, automation, parallel testing, and production readiness
• Partner with business, product, implementation, and state stakeholders to validate requirements and align with regulatory, contractual, and operational expectations
• Oversee multi-vendor and onshore/offshore testing teams, including test execution, defect management, quality outcomes, and delivery timelines
• Develop demand forecasts and resource plans for implementation schedules and operational priorities
• Prepare, manage, and monitor operating and personnel budgets
• Establish and report quality metrics, testing KPIs, defect trends, and executive dashboards
• Identify, assess, and mitigate risks, dependencies, and quality issues
• Drive continuous improvement in testing efficiency, automation adoption, quality outcomes, and client satisfaction
• Support business development through pharmacy testing expertise, implementation strategies, and solution recommendations

Senior Manager, Pharmacy Testing

• Analyze data and help create innovative technologies and solutions for healthcare and human services outcomes
• Analyze, clean, and model data for business decisions and reporting
• Develop and maintain Power BI dashboards, reports, and visualizations
• Use coding and automation to improve data processes and operational efficiency
• Support tax coding and data classification activities
• Translate business requirements into data-driven solutions with business and technical teams
• Use Power BI, GitHub, Copilot Studio, SQL, and Python to analyze and manage data
• Validate solutions through testing and quality assurance
• Communicate insights and recommendations to stakeholders

Business Analyst – Early Career

Call Center Representative

• Answer incoming calls professionally and address member or provider inquiries
• Make outbound calls as needed
• Document all interactions accurately in the system
• Maintain confidentiality and comply with HIPAA and other healthcare regulations
• Research claims and verify insurance
• Resolve member and provider inquiries
• Escalate complex issues to supervisors or appropriate departments
• Meet or exceed performance metrics, including call scripting, quality guidelines, call handle time, customer satisfaction, and schedule adherence

Healthcare Contact Center Agent

Software Engineer

• Design, develop, maintain, and support complex batch processing applications within Linux and Unix environments
• Provide technical leadership by mentoring developers, guiding solution design, conducting code reviews, and supporting all phases of the Software Development Life Cycle in Agile and Waterfall environments
• Collaborate with business analysts, architects, quality assurance teams, and stakeholders to translate business 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
• Help drive modernization through automation, cloud technologies, and DevOps best practices
• Contribute to the design and support of Medicaid healthcare systems, including claims processing, reference systems, PBM, Drug Rebate, ProdDur, batch processing environments, and other mission-critical healthcare applications
• Develop and maintain technical documentation, process flows, and support materials
• Partner with business stakeholders, infrastructure, project management, and quality assurance teams to deliver solutions meeting client and regulatory requirements

Medicaid Batch/Application Developer

• Answer incoming calls from members and providers
• Make outbound calls as needed
• Respond to electronic mail and secure correspondence
• Research claims and verify insurance
• Resolve member and provider inquiries
• Document all interactions accurately in the system
• Maintain confidentiality and comply with HIPAA and other healthcare regulations
• Escalate complex issues to supervisors or appropriate departments
• Meet performance metrics for call scripting, quality, call handle time, customer satisfaction, and schedule adherence

Data Scientist

• Act as Product Owner, Delivery Lead, and Implementation Manager for complex data mining and analytics initiatives
• Design, develop, and implement advanced data mining and AI-driven analytics concepts to identify overpayments and improper payments
• Support and lead responses to client RFPs, contributing written content related to data mining, AI, and payment integrity capabilities
• Translate healthcare regulations, reimbursement methodologies, and clinical policies into scalable audit algorithms and analytic rules
• Lead the incorporation of AI, machine learning, and advanced analytics techniques into payment integrity solutions
• Provide strategic and technical leadership in designing, implementing, and scaling advanced data mining and AI-enabled analytics solutions
• Guide cross-functional teams through complex implementations and ensure successful delivery of payment integrity solutions
• Partner with engineering, clinical, operations, and client teams to safeguard healthcare resources

Data Sciences Advisor

Manager

• Lead and develop multiple reporting and analytics teams supporting operational service delivery organizations
• Build, coach, and inspire high-performing teams
• Foster accountability, collaboration, and continuous improvement
• Ensure accurate, timely, and actionable reporting, dashboards, and performance insights
• Partner with clients, operational leaders, and stakeholders to understand business objectives and reporting needs
• Provide visibility into SLA attainment, operational performance, customer experience, quality, productivity, and business outcomes
• Support performance management and process improvement through data analysis and operational insight
• Identify trends, risks, root causes, and opportunities for operational improvement
• Drive reporting standardization, governance, and quality across teams and accounts
• Partner with technology and transformation teams on automation and modernization initiatives
• Support new client implementations, account transitions, and organizational growth initiatives
• Contribute to go-to-market activities, solution design, and client engagement efforts

Service Delivery Manager

Data Specialist

• Act as Product Owner, Delivery Lead, and Implementation Manager for complex data mining and analytics initiatives
• Design, develop, and implement advanced data mining and AI-driven analytics concepts to identify overpayments and improper payments
• Support and lead responses to client RFPs, contributing written content related to data mining, AI, and payment integrity capabilities
• Translate healthcare regulations, reimbursement methodologies, and clinical policies into scalable audit algorithms and analytic rules
• Lead incorporation of AI, machine learning, and advanced analytics techniques into payment integrity solutions
• Provide strategic and technical leadership in designing, implementing, and scaling data mining and AI-enabled analytics solutions
• Partner with engineering, clinical, operations, and client teams to deliver payment integrity solutions

Data Mining Specialist

• Run and monitor pay cycles for multiple Medicaid clients, ensuring timely and accurate payment processing
• Validate pay cycle data to confirm accuracy and compliance with Medicaid regulations
• Research and troubleshoot discrepancies, resolving issues promptly to maintain smooth operations
• Analyze financial and payroll data to identify trends, prevent errors, and improve efficiency
• Collaborate with internal teams and external stakeholders to ensure seamless financial operations
• Maintain detailed documentation and reporting for audit and compliance purposes

Business Analyst – Financial Operations

• 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