Business Analyst - Medicaid Buy-In Operations

Gainwell Technologies LLC•Topeka, KS

4d•$55,600 - $79,400•Remote

About The Position

As a Business Analyst - Medicaid Buy-In Operations at Gainwell, you will support Medicare Buy-In operations as a subject matter expert, helping Medicare-eligible members with coverage, eligibility, enrollment, and Buy-In questions. The role is suited to someone with Medicare and Medicaid experience, strong analytical skills, and the ability to explain complex healthcare information clearly and compassionately. You will answer Buy-In calls, research eligibility and coverage issues, and coordinate resolutions with internal and external partners. This role helps Medicare beneficiaries access and understand coverage while supporting essential state healthcare programs. Gainwell describes its workplace culture as collaborative, innovative, and inclusive, with opportunities for career growth, learning, and development. The position offers fully remote options from most US locations and territories.

Requirements

Bachelor’s degree or equivalent experience.
At least 3 years of experience in Medicare, Medicaid, healthcare eligibility, enrollment, member services, or operations.
Experience discussing healthcare coverage with members, beneficiaries, providers, or customers.
Strong knowledge of Medicare Parts A and B, Medicare Savings Programs, and Medicaid.
Excellent communication, customer service, analytical, and problem-solving skills.
Ability to explain complex healthcare information clearly and professionally.
Proficiency in Microsoft Office and healthcare systems.
Ability to assist beneficiaries by phone, understand coverage and eligibility rules, and independently resolve complex inquiries with excellent service.
Attention to detail, empathy, professionalism, and confidential handling of sensitive healthcare information.

Nice To Haves

Medicare Buy-In program experience.
Knowledge of CMS regulations, Medicare eligibility, and Medicare Savings Programs (QMB, SLMB, QI, QDWI).
Experience with state Medicaid agencies or government healthcare programs.
Call center, member services, or beneficiary support experience.

Responsibilities

Answer Buy-In calls about coverage, benefits, enrollment, and eligibility.
Explain Medicare Parts A and B, Medicare Savings Programs, and Medicaid Buy-In benefits.
Research and resolve coordination-of-benefits, eligibility, coverage, and enrollment issues.
Document inquiries, findings, and resolutions according to procedures.
Coordinate with members, state agencies, CMS, health plans, and internal teams.
Interpret Medicare and Medicaid policies to resolve inquiries.
Identify trends and process improvement opportunities.
Help develop requirements, procedures, and training materials.
Comply with HIPAA, CMS regulations, and Gainwell policies.