Gainwell Technologies · 5 hours ago
Senior Business Analyst - Pharmacy
United States
Full-time
Remote
Senior Level, Lead/Staff
$65K/yr - $93K/yr
8+ years expGainwell Technologies is focused on leveraging leading-edge technologies to improve the health and well-being of vulnerable communities. As a Senior Business Analyst - Pharmacy, you will play a critical role in ensuring client objectives are met by coordinating business analyst activities, defining business requirements, and improving business processes.
Health CareInformation Technology
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
Qualification
Required
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
Advanced proficiency in analytical and data tools, including: Microsoft Excel (advanced formulas, pivot tables, data validation), SQL for data analysis and validation, Application Lifecycle Management (ALM) or other requirements‑mapping tools
Deep 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
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
Benefits
Generous, flexible vacation policy
401(k) employer match
Comprehensive health benefits
Educational assistance
Leadership and technical development academies
Company
Gainwell Technologies
Gainwell Technologies is a provider of Information Technology & Services. It is a sub-organization of Veritas Capital.
10001+ employees
H1B Sponsorship
Gainwell Technologies has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (90)
2024 (78)
2023 (56)
2022 (96)
2021 (33)
Funding
Current Stage
Late StageTotal Funding
$1M2023-06-06Grant· $1M
Leadership Team
Paul N. Saleh
President and Chief Executive Officer
Gary Call
Chief Medical Officer
Recent News
bloomberglaw.com
2025-12-12
GlobeNewswire
2025-12-11
Company data provided by crunchbase