Gainwell Technologies

Business Analyst

• Analyze claims processing trends and productivity results
• Make recommendations to improve business processes and support clients’ technological aspirations
• Produce daily, weekly, monthly, and ad hoc reports supporting Claims Operations
• Provide actionable recommendations to leadership based on data findings
• Bridge clients, project managers, and technical personnel to define, track, and communicate business requirements and expected impact
• Build basic conceptual data and process models
• Participate in technical reviews and inspections to ensure the intent of change is carried out through every project phase

DevOps Engineer

• Design and build flexible infrastructure and automation solutions
• Collaborate with software developers, system operators, and IT staff to manage development and deployment processes
• Develop and maintain account/region standards and procedures for configuration management
• Interpret configuration management activities and tools and apply them to project activities
• Develop configuration management plans, milestones, and schedules with project managers
• Decompose configuration items into appropriate configuration units
• Identify issues and recommend solutions
• Ensure version control integrity for software and non-software components
• Perform audits according to configuration management plans
• Establish and obtain approval for baselines
• Develop technical installation guidelines and documentation for hardware and software standards
• Develop scripts and automation tools for software releases
• Work with development teams and/or Release Manager on branch and code merge impacts
• Improve the release process
• Research and analyze new software development and configuration management methodologies and technologies
• Create infrastructure as code for a PaaS and cloud-based platform
• Assist lead personnel for assigned accounts/regions
• Provide leadership and work guidance to less experienced personnel

• Design and build flexible infrastructure and automation solutions
• Collaborate with software developers, system operators, and other IT staff to manage development and deployment processes
• Develop and maintain account/region standards and procedures for configuration management
• Interpret configuration management activities and tools and apply them to project activities
• Work with project managers to develop configuration management plans, milestones, and schedules
• Decompose configuration items into appropriate configuration units
• Identify issues and recommend solutions
• Ensure version control integrity for software and non-software components
• Perform audits according to configuration management plans
• Establish and obtain approval for baselines
• Develop technical installation guidelines and documentation for hardware and software standards
• Develop scripts and automation tools to build, integrate, and deploy software releases
• Work with development teams and/or Release Manager to understand branch and code merge impacts
• Improve the release process
• Research software development and configuration management methodologies and technologies
• Interface with in-house teams creating mobile-first and SaaS-based products
• Develop infrastructure as code for the PaaS, cloud-based platform
• Assist lead personnel for assigned accounts/regions
• Provide leadership and work guidance to less experienced personnel

Content Writer

• Document existing CX processes using flowcharts, process maps, and written descriptions
• Conduct gap analyses to identify inefficiencies and suggest improvements
• Write and maintain SOPs and DLPs for CX functional areas
• Review and update documentation to reflect process changes and requirements
• Implement version-control procedures
• Conduct periodic reviews and validations of process documentation
• Gather stakeholder feedback and refine documentation
• Develop documentation standards, templates, tools, and resources
• Collaborate with cross-functional teams and subject matter experts
• Track and report documentation project progress
• Manage work planning, milestone tracking, risk identification, stakeholder coordination, and issue escalation
• Communicate findings, recommendations, and project updates to teams, stakeholders, and management

Process Writer

Pharmacist

• Support prior authorization program builds by translating approved clinical criteria, coverage requirements, client rules, and workflow needs into build requirements
• Partner with cross-functional teams to configure PA workflows, clinical logic, renewals, letters, routing, reporting, and operational processes
• Create and maintain test scenarios, test cases, validation documentation, and requirements traceability
• Participate in QA, unit, integration, UAT, regression, and production testing for PA builds and updates
• Validate PA workflows and clinical logic against approved policies, client requirements, regulations, and operational expectations
• Identify and document configuration issues, workflow gaps, risks, and clinical inconsistencies; support resolution efforts
• Support production readiness by ensuring requirements, testing, documentation, reporting, procedures, and approvals are complete
• Maintain PA criteria, drug class reviews, clinical policies, and evidence-based materials
• Use claims, PA, utilization, quality, and trend data to support analysis, investigations, and program improvements
• Support clinical program operations, including PDL, provider engagement, adherence, safety, specialty pharmacy, quality, and population health initiatives
• Provide senior-level clinical and operational guidance to improve quality, compliance, workflows, and program performance
• Mentor team members on PA workflows, configuration, testing, clinical rationale, and best practices

Principal Clinical Pharmacist

Customer Support

• Assist in keeping projects moving as Gainwell helps clients deliver better health and human services outcomes through technology and innovation
• Lead one or more large project management teams by breaking down larger technological programs and assisting with project staffing
• Spearhead project planning, tracking and oversight of assigned staff by providing direction and deadlines
• Communicate with client, company and project team leadership, measuring and sharing project metrics and status
• Recommend program changes as needed
• Create project schedules, program definitions, budgets and objectives across all project phases
• Manage projects across non-direct reports, escalate risks and implement mitigation solutions
• Prepare detailed SOWs and assist with new proposal efforts and business development

Project Manager – Customer Experience Operations

Human Resources

• Serve as a first point of contact for managers and employees on HR policies, procedures, programs, and general HR guidance
• Support employee relations matters, including employee concerns, issue resolution, performance documentation, and engagement initiatives
• Escalate complex employee relations issues as appropriate
• Provide guidance to managers on goal setting, feedback conversations, and development planning
• Support recruiting coordination, onboarding, internal transfers, and workforce planning activities
• Ensure consistent application of HR policies and compliance with federal, state, and local employment regulations
• Prepare and maintain HR documentation, records, and case notes in accordance with company and confidentiality standards
• Compile and analyze HR reports, dashboards, and metrics to support decision making and identify workforce trends
• Partner with HR Centers of Excellence to support deployment of HR programs and initiatives
• Participate in process improvement initiatives and contribute ideas to enhance efficiency and employee experience
• Maintain current knowledge of HR best practices, employment law updates, and organizational policies
• Perform other duties and responsibilities as assigned

Human Resources Business Partner

Data Analyst

• Collaborate with team members and stakeholders to define key business metrics and gather requirements
• Architect data pipelines
• Design and build dashboards for stakeholders
• Maintain and improve existing data infrastructure and dashboards based on evolving business requirements
• Publish and maintain clear documentation to inform and educate users at scale
• Implement infrastructure changes to improve data landing time
• Partner with leadership to identify data-driven improvements, surface risks or issues, and support solution-based initiatives

Data Analytics and Reporting Subject Matter Expert, SME

Project Manager

• Lead small project management teams assisting in managing components of a larger technological program
• Oversee functional individual contributors by delegating work and providing direction for timely, high-quality completion
• Manage project schedules and scope
• Assist in creating project budgets
• Oversee deliverables for quality and assist in staffing projects
• Identify and mitigate risk through status reporting and project updates
• Manage client, company, and project team performance expectations
• Measure and communicate project metrics and adjust the program as needed
• Prepare detailed statements of work (SOW) for clients
• Gain acceptance and stakeholder approval on project scope

• Strengthen the quality and smooth running of important projects
• Lead one or more medium-sized project management teams and oversee smaller aspects of larger technological programs
• Contribute directly to projects
• Assist in staffing and oversee assigned staff by providing direction and deadlines
• Interface with clients, company leadership, and project team leadership
• Measure and communicate project metrics and recommend program changes
• Create objectives, schedules, program definitions, and budgets
• Identify and mitigate risks through status reporting and project updates
• Prepare detailed statements of work for clients
• Obtain stakeholder agreement and approval on project scope

Senior Project Manager

Business Operations

• 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

Business Process Analysis SME, Medicaid Domain, C/Pro*C Programming

Software Engineer

• Manage configuration and maintenance of Benefit Plans
• Manage configuration and maintenance of Assignment Plans
• Manage configuration and maintenance of Provider Contracts
• Manage configuration and maintenance of Reference Tables
• Manage configuration and maintenance of Rule Metadata
• Manage configuration and maintenance of BPA configuration components used in claims adjudication
• Support configuration governance and release management
• Troubleshoot and provide production support
• Apply Medicaid reference data knowledge to claims, provider enrollment, reimbursement, audits, and policy administration

C/Pro*C Developer – Medicaid BPA Configuration

Backend Engineer

• Serve as the technical lead for assigned functional areas, applications, batch processes, interfaces, or workstreams
• Lead and support technical analysis, design, development, unit testing, implementation, defect resolution, and production support
• Translate functional and business requirements into technical designs, development tasks, implementation plans, and supportable system changes
• Partner with architects, business analysts, developers, QA teams, operations teams, project managers, and client-facing stakeholders
• Review technical designs, code, test evidence, implementation documentation, and production-readiness materials
• Provide technical guidance, mentoring, and day-to-day direction to developers and application team members
• Act as a subject matter expert for assigned applications, data flows, interfaces, batch jobs, functional modules, and system dependencies
• Support issue triage, root cause analysis, defect resolution, system maintenance, and production incident response
• Identify opportunities to improve code quality, batch performance, process efficiency, automation, documentation, and system stability
• Communicate technical risks, dependencies, progress, tradeoffs, and recommendations to project leadership, business stakeholders, and client-facing teams
• Manage a variety of projects without direct access to PHI, PII, or secured/confidential client data

C# .Net Lead – US Healthcare Provider Enrollment

Data Scientist

• Design, build, and train machine learning, deep learning, time series, Gen AI, predictive analytics, NLP, and image processing solutions for healthcare applications
• Develop, test, and deploy AI solutions in cloud and on-premises environments
• Process large healthcare datasets, including data preprocessing, feature engineering, and model training, while ensuring regulatory compliance
• Develop APIs and integrations
• Implement and optimize AI models within Gainwell’s technology stack
• Evaluate models and continuously monitor ML/DL and LLM performance
• Apply security measures and guardrails in Gen AI solutions
• Continuously refine and optimize AI/Gen AI models for accuracy, efficiency, and speed
• Research emerging AI/ML/Gen AI technologies and methodologies
• Ensure AI implementations meet healthcare regulations, ethical AI principles, and data privacy standards
• Identify opportunities to automate workflows and optimize business processes using AI
• Collaborate with software engineers and cross-functional team leads to translate business requirements into deployable solutions
• Support business analysis, requirements documentation, and healthcare reference data activities using governed datasets without direct access to PHI, PII, or secured client data

Data Science AI Engineer, Advisor

Program Manager

• Build and manage client relationships with support from the Program Director, ensuring client satisfaction
• Work with clients to design project approaches and develop implementation plans
• Oversee and manage contracts, specific products/services, or special projects
• Continuously monitor and report progress toward business goals to leadership
• Manage, prepare, and monitor budgets and revenue expectations for assigned clients
• Potentially supervise additional account management staff, such as Program Specialists
• Project manage across non-direct reports and recommend program changes as needed
• Escalate risks quickly and implement risk mitigation solutions
• Communicate with client, company, and project team leadership
• Measure and share project metrics and status