Advisor Business Analyst - Claims Configuration

analyzing X12 healthcare transactions, including 837 and 835 transaction data and associated remittance adjustment reason codes.

Proven ability to independently analyze complex claim scenarios, identify root cause, assess impact, and develop actionable business and configuration solutions.

leading or mentoring Configuration Business Analysts and reviewing technical or functional work products.

Strong client-facing communication, facilitation, presentation, documentation, and stakeholder-management skills.

working within SDLC, Agile delivery, testing, release management, and production-support environments.

Bachelor’s degree in Computer Science, Information Systems, Health Informatics, Business Administration, or a related field, or an equivalent combination of education and relevant experience.

What sets you apart Experience supporting Medicaid claims configuration in a multi-account CEF Maintenance & Operations environment.

Deep expertise in provider contracts, fee schedules, alternative payment methodologies, capitation, benefits, edits, and claims rules.

with operational monitoring, trend analysis, claims inventory analysis, first-pass outcomes, denials, and reprocessing impacts.

Knowledge of CMS guidance, state Medicaid policy, MITA, encounter processing, financial reconciliation, and compliance considerations.

with IT service management and work-tracking tools such as ServiceNow, Jira, or similar platforms. Ability to balance client priorities, production risk, operational urgency, and long-term configuration sustainability What you should expect in this role Fully remote options from most U.S. locations and territories. Video cameras must be used during all interviews and during the initial week of orientation. Work may include production support, priority issue resolution, scheduled releases, and coordination across multiple client and internal teams. This job description may be refined to align with approved requisition, job profile, location, compensation, and Talent Acquisition requirements. The deadline to submit applications for this posting is September 24, 2026 Please ensure you join all screenings, interviews and meetings from a quiet location with a stable internet connection. Video is required for screenings and interviews, so please test your camera and microphone in advance. Do not use AI tools, virtual backgrounds/filters, or visual enhancements during the interview. #LI-HC1 The pay range for this position is $92,900.00 - $132,700.00 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), age, 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.