Senior Business Analyst - Pharmacy

Senior Business Analyst - Pharmacy

Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. 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.

Your role in our mission:

• Play a critical part in ensuring Gainwell is meeting our clients' objectives in pharmacy benefit management (PBM) services.
• Support PBM or Drug rebate implementations and configurations
• Support PBM operations and maintenance on established accounts
• Work with a team of pharmacy clinicians and subject matter experts to configure the pharmacy systems to deliver services to our state clients.
• Assist in implementation of a pharmacy payer system.
• Perform Pharmacy updates including benefit plan design, edit/audit set up, utilization controls, PDL, configuration updates, and auto prior authorization parameters
• Be a knowledgeable bridge between operations staff, clients, project managers and technical staff to define, document and share pharmacy business requirements and expected impact
• Work with the client to develop business rules and configuration requirements
• 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
• Testing point of sale (POS) pharmacy claims as required
• 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:

• Six (6) or more years of experience in a relevant pharmacy business analyst or pharmacy technician position with 3 or more years of Medicaid and Medicare experience preferred
• Knowledge of computer programming concepts such as configuration, development, data conversion analysis and batch processing
• Advanced knowledge in analytical software such as Microsoft Excel or SQL and other requirement-mapping tools such as Application Lifecycle Management (ALM) tools
• Strong communication skills, including translating client needs into actionable objectives and presenting effectively to business, technical, and executive audiences
• Strong analytical abilities with experience in business process re-engineering and problem solving
• Highly organized with the ability to prioritize tasks, manage workload effectively, and operate independently
• Pharmacy Requirements:
• Pharmacy Experience as a Pharmacy Technician or working for a PBM
• Knowledge of drugs and drug file structures through FDB, Medispan, or Micromedex
• Knowledge the pharmacy payer process/claims processing
• Experience working with drug file data or NCPDP guidelines
• Knowledge of prior authorization processes and criteria preferred

What you should expect in this role:

• Remote opportunity from most US locations
• Possibility of up to 10% travel for client meetings/requirement review or implementations
• Video cameras must be used during all interviews, as well as during the initial week of orientation
• The deadline to submit applications for this posting is September 1, 2026
• The pay range for this position is $64,900.00 - $92,700.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.
• 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.

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.