Senior Business Analyst - Pharmacy

Gainwell Technologies LLC

26d•$64,900 - $92,700•Remote

About The Position

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities. SummaryAs a Senior Business Analyst - Pharmacy at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position.Your role in our missionPlay a critical part in ensuring Gainwell is meeting our clients’ objectives in important areas.

Requirements

8+ years of experience in a relevant Business Analyst position with 4-5 or more years of Medicaid and Medicare experience
5 or more years of Claims experience, preferably Professional / Pharmacy experience
Proven ability to translate complex client and regulatory requirements into clear, actionable business and technical objectives
Strong analytical, problem‑solving, and business process re‑engineering skills, with experience driving operational and system improvements
Microsoft Excel (advanced formulas, pivot tables, data validation)
SQL for data analysis and validation
Application Lifecycle Management (ALM) or other requirements‑mapping tools
Claims experienceDeep domain knowledge of Medicaid claims processing, including:
MMIS and T‑MSIS (including EDITMSIS)
EDI claims transactions
Pharmacy claims interpretation
Drug Utilization Review (DUR), including Prospective (Pro‑DUR)
Demonstrated ability to analyze, interpret, and troubleshoot pharmacy and medical claims data, edits, and adjudication outcomes
Strong understanding of claims configuration concepts, including batch processing, system edits, and downstream impacts across MMIS and reporting systems
Proven ability to translate complex client and regulatory requirements into clear, actionable business and technical objectives
Strong analytical, problem‑solving, and business process re‑engineering skills, with experience driving operational and system improvements
Excellent client‑facing communication skills, with the ability to engage stakeholders at all levels, including business leaders, clients, and technical teams
Demonstrated executive presence, capable of delivering clear, confident messaging to senior leadership and external partners
A collaborative leader who motivates others to action, communicates complex technical concepts in a digestible manner, and drives alignment across teams
Ability to work independently with minimal oversight, while also functioning cohesively within cross‑functional and matrixed teams

Responsibilities

Help coordinate a business analyst team’s duties and activities on IT projects and nurture newer team members by providing guidance and support
Be a knowledgeable bridge between clients, project managers and technical staff to define, document and share business requirements and expected impact
Work with the client to develop business specs at the start of a technical project
Analyze, plan, design, document or make recommendations to improve business processes to support client’s technology goals
Help verify that all requirements have been met by approving and validating test results
Exercise your ability to use basic analytical or relational database software — such as Excel or SQL — to quantify the anticipated impact of work