Senior Business Analyst - Pharmacy

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.

Summary

As a Senior Business Analyst - Pharmacy 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. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position.

Your role in our mission

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 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 

What we're looking for

• 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

Claims experience

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

Additional skills & competencies

• 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
• 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