Gainwell Technologies

Analyst

• Support the execution and optimization of enterprise Verint Quality Management (QM) and Automated Quality Management (AQM)
• Translate business, operational, and compliance requirements into clear, well-documented system configurations
• Assist with pre-go-live testing, post-go-live stabilization, and production validation
• Maintain clear documentation to enable knowledge transfer and reduce single-point dependency
• Partner with Quality leaders and operational stakeholders to understand business needs
• Support reporting and enablement teams by providing configuration context and functional inputs
• Support configuration of Automated Quality Management (AQM), including eligibility rules and automation logic
• Gather, analyze, and document detailed business and functional requirements

Operational Analyst – Verint Quality Execution

Data Entry

• Enter and verify claims information, supporting documentation, and healthcare records with a high degree of accuracy.
• Review claims forms and related documents to ensure data is complete, accurate, and compliant with established procedures.
• Maintain confidentiality and security of sensitive healthcare and member information.
• Meet established productivity, quality, and accuracy standards while managing daily workloads.
• Utilize multiple systems and Microsoft Office applications to support claims processing and operational objectives.

Healthcare Data Entry Specialist

IT Support

• Serve as the first point of contact for healthcare providers
• Answer inbound calls and respond to EDI-related inquiries
• Research and troubleshoot provider issues
• Conduct outbound follow-ups for timely resolution
• Process provider and member updates while maintaining standards

EDI Helpdesk Representative

Manager

• Own the full vendor management lifecycle for outsourced contact center partners
• Set vendor expectations and performance standards
• Develop and execute Statements of Work (SOWs)
• Manage vendor performance through weekly operating reviews
• Serve as the primary point of contact between vendors and internal stakeholders
• Identify performance risks and improvement opportunities
• Establish and enforce vendor management standards
• Partner with internal teams and vendors for improvement and innovation

CX Vendor Manager

Pharmacist

• Support members, providers, and pharmacies by responding to pharmacy-related inquiries, benefit questions, prior authorization requests, and claims-related issues
• Research and resolve pharmacy claims, eligibility, coverage, and medication-related concerns while maintaining service level expectations
• Review, document, and process pharmacy transactions and requests in accordance with client, regulatory, and operational guidelines
• Utilize multiple systems and resources to accurately investigate issues, provide resolutions, and maintain complete documentation
• Collaborate with internal teams, healthcare professionals, and external stakeholders to support quality service delivery and member satisfaction

Certified Pharmacy Technician

Business Analyst

• Play a critical part in ensuring Gainwell is meeting our clients’ objectives in important areas
• Help coordinate a business analyst team’s duties and activities on IT projects
• Nurture newer team members by providing guidance and support
• Be a knowledgeable bridge between clients, project managers and technical staff
• 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
• Help verify that all requirements have been met by approving and validating test results
• Use basic analytical or relational database software — such as Excel or SQL

Senior Business Analyst

Consultant

• Analyze and apply state policy in a variety of situations, including client meetings and suspended claims reviews
• Serve as a subject matter expert on State policy and provide consultation and guidance to clients
• Respond to client referrals in a timely manner
• Recommend process improvements and approved modifications to support operational effectiveness and industry competitiveness
• Identify potential opportunities for additional products or services and collaborate with the business development team as needed

Nurse Consultant

• Play a critical part in ensuring Gainwell is meeting our clients’ objectives in pharmacy benefit management (PBM) services
• Support Preferred Drug List (PDL) and supplemental rebate implementations and configurations
• Support PDL and supplemental rebate operations and maintenance on established accounts
• Work with a team of pharmacy clinicians and subject matter experts to configure PDL and rebate systems to deliver services to our state clients
• Apply analytical skills to evaluate and model various rebate scenarios, providing insights for decision-making
• Perform system updates related to PDL and rebate configurations to ensure accuracy and compliance
• Analyze, plan, design, document or make recommendations to improve business processes to support client’s technology goals
• Execute testing for PDL and rebate system changes to ensure functionality and reliability
• 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

Business Analyst – Preferred Drug List

• Work with the client, Gainwell business teams, Gainwell technical teams, and other vendors to identify and develop business and technical solutions
• Analyze CoreMMIS reports to resolve discrepancies/errors
• Develop requirements, business designs, and business processes for required system changes
• Develop and/or coordinate creation of ad hoc reports to monitor, support, and analyze Provider Enrollment processes
• Participate in internal and external committees and workgroups as requested
• Project a positive, professional attitude in a fast-paced environment
• Effectively manage time and work independently in a strong team environment

Experienced Business Analyst – Provider Enrollment

Content Writer

• Process Documentation: work closely with Lean Six Sigma Black Belts and CX teams to document existing processes through detailed flowcharts, process maps, and written descriptions
• SOP Development: write and maintain clear, concise, and standardized Standard Operating Procedures (SOPs) for all CX functional areas
• Quality Assurance: conduct periodic reviews and validations of process documentation to ensure it reflects actual operations and complies with operational standards
• Training Support: collaborate with the training department to align training materials with documented processes
• Documentation Standards: develop and implement documentation standards and best practices to ensure consistency and usability across all CX processes
• Collaboration: work with cross-functional teams to gather information, clarify process details, and ensure comprehensive documentation
• Reporting and Communication: track and report progress on documentation projects, ensuring deadlines are met and deliverables are of high quality

Process Writer

Business Operations

• Analyzes, plans, and implements moderately complex operational process improvement needs
• Acts as a re-engineering consultant to other transformation teams in methods, techniques, and tools
• Works closely with Lean Six Sigma Black Belts and CX teams to document existing processes
• Conducts a thorough gap analysis to identify inefficiencies and suggesting improvements
• Writes and maintains clear, concise, and standardized Standard Operating Procedures (SOPs)
• Conducts periodic reviews and validations of process documentation to ensure compliance with operational standards
• Collaborates with the training department to align training materials with documented processes
• Creates and maintains documentation templates, tools, and resources

Business Process Consultant, Green Belt

• Facilitate Kaizen Events: Lead and manage kaizen event workshops to map out and design the designed state of processes
• Analyze and Improve Processes: Employ Lean Six Sigma methodologies to conduct thorough analyses of designed processes
• Project Management: Take ownership of process improvement projects from inception to completion
• Robust Reporting & Insights: Work closely with the CX Insights team to design and implement measurement systems that effectively track key performance indicators (KPIs), service level agreements (SLAs), and other relevant metrics
• Operational Readiness: Assess and ensure that all systems, processes, and technology are fully operational and ready for deployment before the go-live date
• Continuous Improvement: Lead initiatives to drive ongoing improvements in customer experience and operational efficiency
• Root Cause Analysis: Conduct in-depth root cause analysis to address and resolve issues that arise during DDI projects.

Business Process Consultant

• Coordinate the adoption of information security best practices throughout the company based on user feedback and industry standards.
• Communicate effectively with internal teams to address user concerns and optimize security compliance.
• Support IAM operations efforts including access reviews, control execution, and audits.
• Participate and represent IAM on projects and team calls to ensure security requirements are achieved in compliance with standards and policy.

Senior Identity and Access Management Analyst

Solutions Engineer

• Provide thought leadership and technical direction to the data engineering team
• Understand and translate business requirements to data strategies
• Design, develop and enforce standards for data storage and governance
• Work closely with enterprise and application architects
• Develop, document and maintain overall view of data platform architecture
• Provide training for data engineers, platform engineers and ETL developers
• Document and publish technical principles and mentor the data engineering team

Experienced Solution Architect

Data Analyst

• Elicit, analyze data, and document business requirements for software development projects
• Work closely with stakeholders, end-users, project managers, and developers
• Help translate business objectives into technical solutions
• Support the software development lifecycle from inception to implementation
• Gather, analyze, and document functional and non-functional requirements
• Act as a liaison between stakeholders and technical teams
• Create and maintain SOWs, user stories, process flows, and training materials
• Support UAT, identify and resolve defects, and assist end-users during testing and go-live phases
• Assist with project planning, tracking, and change management