Advisor Claims Business Analyst
Gainwell Technologies · New York, United States
- Hybrid
- Full-time
- $100,000 / year
- New York, United States
Tailored resume — keyword-matched to this role.
Hiring manager — we find who's hiring.
Intro email — drafted to reach them directly.
Job highlights
- Analyze claims data for improvements.
- Investigate complex claims issues.
- Recommend solutions and document systems.
- Collaborate with cross-functional teams.
- Develop insights through reporting and dashboards.
About the role
About Gainwell Technologies
Gainwell Technologies is a company 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.Summary
As an Advisor Claims Business Analyst at Gainwell, you will support end-to-end claims workflow analysis, configuration support, and complex issue resolution within the MMIS ecosystem. This role provides advanced (L2) support for claims operations by leveraging deep expertise in Medicaid claims adjudication, data analysis, and cross-functional collaboration. You will drive root-cause analysis, identify trends, and recommend solutions that improve first-pass rates, reduce denials, and support client and organizational objectives.Your role in our mission
When joining Gainwell, you will:- Analyze claims data to identify denial trends, operational bottlenecks, and opportunities to improve first-pass rates and reduce rework
- Perform in-depth investigation of complex claims issues, determining root causes across policy, data, user, or configuration factors
- Provide actionable recommendations and detailed documentation to support issue resolution, enhancements, and system improvements
- Collaborate with cross-functional teams (e.g., operations, IT, policy, finance) to reconcile claims outcomes and ensure data integrity
- Develop reporting, dashboards, and monitoring tools to provide insights and support leadership decision-making
What We're Looking For
- 9+ years of experience in claims business analysis, configuration, or healthcare operations, with strong experience in end-to-end claims workflows
- Advanced knowledge of healthcare claims processing, including coding (ICD-10, CPT, modifiers), billing, and adjudication rules
- Strong SQL skills and experience analyzing large datasets to identify trends, root causes, and performance improvements
- Proven ability to solve complex issues, translate technical findings into business insights, and work within client/vendor environments
- Strong communication, collaboration, and stakeholder engagement skills; experience in Medicaid or Medicare environments preferred
What You Should Expect In This Role
- Remote-based role within the United States
- Video cameras must be used during all interviews, as well as during the initial week of orientation
- This posting is intended for pipelining. This is a developing position therefore the job description is subject to change
- Business Analyst Claims Coding-10, CPT, modifiers
Compensation and Benefits
The pay range for this position is [[salaryMin]] - [[salaryMid]] per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities. We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings. Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.Key skills/competency
- Claims Analysis
- Business Analysis
- Healthcare Operations
- Medicaid/Medicare
- SQL
- Data Analysis
- Root Cause Analysis
- Claims Adjudication
- Cross-functional Collaboration
- Stakeholder Engagement
Skills & topics
- Claims Business Analyst
- Healthcare Claims
- MMIS
- Medicaid
- Medicare
- SQL
- Data Analysis
- Root Cause Analysis
- Business Analysis
- Healthcare Operations
How to get hired
- Tailor your resume: Highlight your 9+ years of claims business analysis experience, SQL skills, and healthcare operations expertise. Emphasize your work in Medicaid or Medicare environments.
- Showcase problem-solving: Detail instances where you've performed root-cause analysis on complex claims issues and implemented effective solutions.
- Demonstrate technical skills: Provide specific examples of your advanced SQL usage for data analysis and your knowledge of healthcare coding (ICD-10, CPT, modifiers).
- Prepare for interviews: Be ready to discuss your collaboration style and how you translate technical findings into actionable business insights.
Technical preparation
Master SQL for complex data queries.,Practice analyzing healthcare claims data.,Review ICD-10, CPT, and modifier codes.,Familiarize yourself with MMIS systems.
Behavioral questions
Describe a complex claims issue you resolved.,How do you collaborate with cross-functional teams?,Explain how you translate technical findings to business.,How do you handle competing stakeholder priorities?
Frequently asked questions
- What are the key responsibilities for an Advisor Claims Business Analyst at Gainwell Technologies?
- As an Advisor Claims Business Analyst at Gainwell Technologies, you will analyze claims data, investigate complex claims issues, provide solutions, collaborate with teams, and develop reports and dashboards to improve claims processing and reduce denials.
- What qualifications are required for the Advisor Claims Business Analyst role at Gainwell?
- The role requires 9+ years of experience in claims business analysis or healthcare operations, advanced knowledge of healthcare claims processing including coding, strong SQL skills for data analysis, and excellent communication and collaboration abilities. Experience in Medicaid or Medicare environments is preferred.
- Is the Advisor Claims Business Analyst position remote?
- Yes, the Advisor Claims Business Analyst position at Gainwell Technologies is a remote-based role within the United States.
- What is the expected work arrangement for interviews and onboarding at Gainwell Technologies?
- Video cameras are required for all interviews and for the initial week of orientation at Gainwell Technologies.
- How does Gainwell Technologies support employee development for an Advisor Claims Business Analyst?
- Gainwell Technologies supports employee development through opportunities for career growth, technical credentials and certifications, a flexible vacation policy, educational assistance, and comprehensive leadership and technical development academies.
- What kind of data analysis is expected from an Advisor Claims Business Analyst at Gainwell?
- The Advisor Claims Business Analyst is expected to analyze large datasets using strong SQL skills to identify denial trends, operational bottlenecks, root causes, and performance improvements within the claims workflow.
- What is the role of collaboration for an Advisor Claims Business Analyst at Gainwell?
- Collaboration is crucial for an Advisor Claims Business Analyst at Gainwell. You will work with cross-functional teams such as operations, IT, policy, and finance to reconcile claims outcomes and ensure data integrity.
- Does Gainwell Technologies offer benefits to its salaried, full-time employees?
- Yes, Gainwell Technologies offers a generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance to its salaried, full-time employees.