Job Title: Professional Business Analyst - Claims
Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development.
Summary
As a Professional Business Analyst - Claims 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. In this intermediate-level role, you will support multiple, less complex projects by analyzing business needs, documenting requirements, participating in client discussions, and serving as a liaison between business and technical teams. You will apply established practices and independent judgment to evaluate business issues, recommend practical solutions, and help ensure technology changes align with client objectives.
Your role in our mission
Play an important role in helping Gainwell meet our clients objectives in key operational and technology areas.
- Assist in planning and designing business processes; help formulate recommendations that improve and support client business activities.
- Analyze and document client business requirements and processes for moderately complex projects, and communicate those requirements clearly to technical personnel.
- Participate in client meetings and facilitate moderately complex discussions to gather and document requirements and explore potential solutions.
- Develop and modify systems requirements documentation to meet client needs; independently document requirements for simple projects or assigned subsystems.
- Participate in technical reviews and inspections to verify that the intent of a change is carried through each phase of the project.
- Use business solutions and analytical tools, such as Excel and basic relational database concepts, to evaluate information and support recommendations.
What we're looking for
Key experiences:
- Medical claim adjudication knowledge and experience across multiple payers.
- Experience with creating functional requirements documentation like DSDs (Design Specification Document) and BRDs (Business Requirements Document).
- Configuration of claims related business rules based on policy, business, and technical requirements
Additional experience:
- 5 years of experience in a Business Analyst, systems analyst, or related role working with information technology and functional business groups.
- A bachelor s degree in a technical or business discipline, or equivalent combination of education and experience.
- Intermediate knowledge of requirements determination, documentation, analysis, evaluation/validation, traceability, prioritization, and requirements change management.
- Ability to decompose high-level information into detailed low-level information, and distinguish requests from needs and requirements from solutions.
- Functional analytical, problem-solving, presentation, personal computer, and business solutions software skills.
- Effective verbal and written communication skills, with the ability to build relationships, work collaboratively, and manage difficult client interactions professionally.
- Experience working with business processes and process improvement concepts.
- Experience with project and change management tools such as ALM, iTrace, or rTrace preferred.
- Experience developing structured user manuals, training documentation, business rules models, or requirements traceability preferred.
- Health Care, Health Insurance, Medicaid, MMIS, or claims-processing experience preferred, including familiarity with Institutional and Professional/Physician claim forms and related concepts such as Prior Authorization, Member, Provider, Long-Term Care, Inpatient, and Outpatient processing.
What you should expect in this role
Office hours for this position are 8:00 am to 5 pm mountain time.
Fully remote options from continental US locations only.
Video cameras must be used during all interviews, as well as during the initial week of orientation.
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