Gainwell Technologies

Analyst

• Reviews Medicaid Drug Rebate payments from drug manufacturers to identify rebate disputes and resolve outstanding balances
• Contact pharmacy and medical providers to verify claims data
• Contact drug manufacturers for information on disputed rebates
• Provide training for new hires and act as a subject matter expert to team
• Assist in required CMS reporting and invoicing as needed
• Act as backup for Drug Rebate Supervisor tasks as needed
• Assist the Supervisor in monitoring dispute workflow
• Lead efforts to focus efforts on the highest materiality disputes
• Assist with claim load file quality validation
• Research disputed pharmaceutical utilization to prepare dispute resolution proposals
• Negotiate with drug manufacturers to resolve disputes fairly and accurately
• Complete required productivity tracking reports
• Track and prioritize dispute resolution activities on an ongoing basis
• Review and resolve invoices in assigned workflow queues on a daily basis
• Follow up with drug manufacturers to secure payment for unpaid invoices
• Interact with internal and external customers to accomplish goals
• Other tasks as directed

Senior Drug Rebate Analyst

• Review, research, and resolve medical claims in accordance with established processing guidelines and procedures.
• Analyze claims issues and coordinate with internal departments to ensure timely and accurate resolution.
• Prepare and process claim-related documentation, including Return to Provider (RTP) forms when required information is missing or invalid.
• Manage multiple priorities while maintaining productivity, accuracy, and service-level expectations.
• Communicate claim status, workload updates, and potential issues to leadership and business partners as appropriate.

Medical Claims Resolution Analyst

Consultant

• Conducting clinical and financial pre-payment compliance reviews to detect, combat, and eliminate fraud, waste, and abuse in the Medicaid program.
• Consulting on the development and implementation of pre‑payment review policies and guidelines that support OIG program objectives.
• Perform comprehensive medical record reviews and analyze complex datasets and systems.
• Develop, establish, and implement pre‑payment review criteria across multiple service areas.
• Process pre‑payment reviews according to medical necessity criteria, administrative code, and other requirements.

Pre-Payment Review Nurse Consultant

Program Manager

• Manage delivery of end-to-end product solution across multiple delivery areas
• Lead programs to successfully deliver and support complex product solution implementations
• Oversee planning, execution, risk management, stakeholder alignment, and delivery across multiple areas
• Serve as the primary point of coordination between business stakeholders and delivery teams throughout the implementation lifecycle

Program Manager – Pharmacy Benefits

Database Administrator

• Lead client and project engagements to assess requirements and define database design strategies
• Analyze user needs and develop technical specifications ensuring performance, security, and data integrity
• Design, develop, implement, and maintain database solutions, including automation of data processes and reporting capabilities
• Monitor and optimize database performance, manage production support activities (e.g., backup/recovery, archiving), and implement standards
• Drive continuous improvement by maintaining documentation, evaluating emerging technologies, and providing guidance to junior team members

Experienced Database Administrator

Business Analyst

• Play a critical part in ensuring Gainwell is meeting our clients’ objectives in important areas
• Under minimal direction, formulate and define system scope and objectives based on both user needs and a good understanding of information technology, business processes, and industry requirements
• Act as a liaison between client and technical solutions/support groups, using advanced communication skills to elicit, document, analyze and validate client requirements
• Apply extensive knowledge of the client’s business and industry to develop requirements specifications
• Document requirements and translate into proper system requirements specifications using high-maturity methods, processes, and tools
• Develop visualization, user experience and configuration elements of solution design
• Execute and coordinate requirements management and change management processes
• Develop and maintain internal and external relationships to support management of scope and expectations
• Participate in proposals, feasibility studies, implementations, and new business development
• Operates as a team member and as a team leader
• Advise on methods to improve business processes

• Play a key role in delivering high-quality business analysis support across projects, contributing to the success of system implementations and enhancements.
• Develop and own structured solution artifacts that define discrete system changes or work products, driving them end-to-end from initial definition through stakeholder review, build coordination, testing alignment, implementation, and closure.
• Elicit, document, and manage business, functional, and non-functional requirements, translating business needs into clear, actionable deliverables for technical and project teams.
• Support development of project deliverables, including requirements, design documentation, and user-facing materials.
• Analyze business processes and system impacts across functional areas, identifying opportunities to improve efficiency, accuracy, and alignment with project objectives.
• Participate in and support requirements workshops, design sessions, and client walkthroughs.
• Ensure adherence to established standards, templates, and naming conventions across deliverables.
• Maintain project coordination and communication activities, including capturing and distributing meeting minutes, tracking status of work items, and providing regular updates to Project Managers, Business Leads, and other stakeholders.
• Provide guidance and support to junior BAs, contributing to team consistency and development.

Senior Business Analyst

• support complex healthcare IT initiatives by translating business needs into well-defined, high-quality system solutions
• contribute to requirements, design, and testing activities while partnering with project teams
• ensure solutions are complete, accurate, and aligned with client expectations
• work closely with project leadership, technical teams, and client stakeholders to deliver outcomes that improve care delivery and operational effectiveness for Wisconsin Department of Health Services, Medicaid members, and providers
• develop and own structured solution artifacts that define discrete system changes or work products
• elicit, document, and manage business, functional, and non-functional requirements
• analyze business processes and system impacts across functional areas
• participate in and support requirements workshops, design sessions, and client walkthroughs
• maintain project coordination and communication activities

• Lead business analysis efforts for complex, high-impact healthcare initiatives
• Serve as the Project Business Lead for the Pharmacy F6 / NCPDP upgrade
• Partner with project leadership and client stakeholders to translate business needs into high-quality system solutions
• Coordinate with the Test Lead and testing team to ensure alignment of test scenarios and test cases

Experienced Business Analyst – Project Business Lead, Pharmacy F6, NCPDP Upgrade

Data Engineer

• Participation and representation in a client facing Data Governance Committee, including making recommendations, guiding decisions and recommendations within the scope of Client, State and Federal data governance policies, practices, and standards relevant to data management
• Ensure and maintain to the highest standards the quality and security of data within program engagement through adherence to processes and procedures for access controls and monitoring of data activities and use to protect data integrity, including ensuring compliance for the preservation and protection of Protected Health Information (PHI) and Protected Identification Information (PII)
• Collaborate with stakeholders in the design, testing, implementation and ongoing maintenance and support activities of data services
• Assist the Client in solving data-related issues by managing data corruption or mapping data between program areas
• Maintain internally established data quality reporting metrics, evaluate, and identify issues/corrections and coordinate and implement data management best practices
• Identify data assets, lineage, and business rules within data domains to ensure data element continuity and avoid data conflict
• Manage data design, creation and management of database architecture and data repositories
• Maintain accurate and current content within the data management plan including all diagrams, workflows, and all other data related documentation
• Conduct and comply with data reviews and auditing to ensure adherence to current standards, policies and design of the database architecture and repositories
• Ensure documentation and processes are followed, including Architectural Board approvals and other necessary approvals, for all data architecture changes

Data Architect

• Take charge and focus on how we can meet critical needs to help clients deliver better health and human services outcomes.
• Coordinate workstreams and teams on IT projects to align solutions with client business priorities.
• Demonstrate your knowledge as MMIS SME and liaison for clients and internally between technical and non-technical workers to transform requirements into real results.
• Delegate work across teams, and coach and monitor project team members to plan, design and improve complex business processes and modifications.
• Streamline workflows across clients and technical personnel to determine, document and oversee carrying out system requirements.
• Support quality control as you approve and validate test results to verify that all requirements have been met.
• Serve as a trusted advisor and proxy to the functional lead, ensuring alignment of priorities, risks, and execution across all provider initiatives.
• Act as the operational backbone for the Provider workstream, driving day-to-day execution while enabling leadership to focus on strategic priorities.
• Partner closely with leadership to translate strategic direction into actionable plans, timelines, and deliverables.
• Provide leadership continuity, stepping in to lead discussions, decisions, and escalations when required.

• Become a healthcare insurance subject matter expert with sufficient technical skills to produce proof-of-concept solutions to various issues within the industry.
• Perform data cleaning and analysis using SQL, Python, and AI models.
• Analyze big data from diverse sources to identify trends, address gaps, and discover improvement opportunities that align with improving the healthcare system.
• Provide subject matter expertise in identifying product uses and designing strategies that address significant business and technical challenges.
• Gather and translate business requirements into analytical applications and advanced dashboard visuals, reports, or other alert systems.
• Document code using documentation tools and participate in collaborative team code reviews.
• Collaborate with various teams within the company to advise on technical solutions.
• Stay informed on industry trends, best practices, and innovations, ensuring competitive market relevance of company products.

Business Data Engineer

Project Manager

• Creates and implements complex project definitions, schedules, budgets, and objectives for a large sized or multiple projects of high complexity.
• Determines need for and impact of changes in scope of project and makes and implements recommendations based on determinations.
• Gains concurrence, approval, and consensus from stakeholders regarding the various project aspects, adjusts accordingly.
• Identifies appropriate resources and staffs projects.
• Organizes project team(s) members to ensure communication and understanding of deadlines, assignments and objectives.
• Acts as the point of contact with client project management.
• Identifies, when and as appropriate, staffing changes or needs as project progresses.
• Manages costs, schedules and quality by overseeing project deliverables.
• Ensures schedule and budget are met.
• Identifies need for change, determines course of action and revises as appropriate.
• May act outside of established policies as necessary.
• Oversees the ongoing review of project(s) status; identifies risks.
• Develops, recommends and implements risk mitigation solutions and implements as appropriate.
• Works in conjunctions with team members and stakeholders to anticipate and manage changes to projects, such as but not limited to, technical requirements, business requirements and schedule.
• Determines when additional resources are needed and implements same.
• Identifies or gathers information regarding possible solutions that may create additional, different or unique project objectives or results.
• Manages client project management, company management and project team expectations for agreed upon project performance by obtaining and providing project metrics.
• Identifies, recommends and implements changes or alternate paths based upon performance and metrics.
• Develops and makes presentations that could lead to expanded business opportunities.
• Participates in proposal efforts and sales calls to enhance opportunities for future business deals with client.
• Manages client expectations and balances the needs of company and client to ensure satisfaction for relevant parties.
• Oversees assigned personnel for projects.

Principal – Project Management

• Prepares work statements, scope/priority definitions, budgets and schedules for assigned moderately complex programs.
• Prepares documents with appropriate standards to meet client requirements and needs
• Assists in the staffing of projects.
• Organizes project team members to ensure communication and understanding of deadlines, assignments and objectives.
• Participates in work as applicable.
• Assists in documentation of program progress including implementation, timelines, issues, risks and successes to maintain program course.
• Conducts analyses to identify risks on the program.
• Works in conjunction with team to ensure program requirements are met as determined by established deliverables; ensures adherence to those deliverables; communicates milestones and commitments.
• Provides and assists in providing information regarding possible solutions that may create additional, different or unique project objectives or results.
• Manages client, company and project team expectations for agreed upon project performance by obtaining and providing project metrics.
• Recommends changes or alternate paths based upon performance and metrics.
• Works on the feedback provided by the client on program results; and incorporates same into future programs.
• Identifies and determines global implications of program parameters and redefines, redesigns or revises as appropriate.
• Prepares and recommends program operating and personnel budgets for approval.
• Monitors spending for adherence to budget, reviews and recommends variances as necessary.
• May provide leadership and work guidance to less experienced personnel.

Senior Professional, Program Management

Software Engineer

• Code, test, debug, implement, and document low to moderately complex programs
• Create appropriate documentation in work assignments
• Design systems and programs to meet business needs
• Prepare detailed specifications from which programs are developed and coded
• Ensure programs meet standards and technical specifications

Senior Drug Rebate Analyst

Medical Claims Resolution Analyst

Pre-Payment Review Nurse Consultant

Program Manager – Pharmacy Benefits

Experienced Database Administrator

Business Analyst

Senior Business Analyst

Senior Business Analyst

Experienced Business Analyst – Project Business Lead, Pharmacy F6, NCPDP Upgrade

Data Architect

Business Analyst

Business Data Engineer

Principal – Project Management

Senior Professional, Program Management

Advisor Batch Developer – UNIX, C, SQL