Business Analyst - Claims Adjudication / Financial
$55.6k - $79.4kGainwell Technologies LLC
Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. As a Business Analyst - Claims Adjudication / Financial 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. Gainwell empowers you show you’re a pro and help clients deliver better health and human services outcomes using innovative technology and solutions. Analyze, plan, design, document and make recommendations to improve business processes to support client’s technological aspirations Be a supportive bridge between clients, project managers and technical personnel to define, track and communicate business requirements and their expected impact by building basic conceptual data and process models Ensure that “intent of change” is carried out through every project phase by participating in technical reviews and inspections Three or more years of Business Analyst experience translating technical goals and requirements into real action for clients A fundamental understanding of healthcare claims adjudication and financial processing Knowledge of basic computer programming concepts such as configuration, development and batch processing Advanced knowledge in Microsoft Excel and other software for conducting quantitative analysis Strong analytical and business process re-engineering skills Strong written and oral communication and presentation skills to deliver messages to business leaders, clients and technical personnel An influencer and team player who that motivates others to action and communicates key technical ideas in a digestible way Fully remote options from most US locations and territories 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 November 5, 2026
- LI-Healthcare Claims
- LI-Business Analyst Financial
$55.6k - $79.4k
...to propel their operations. Join the group that solves business challenges and enhances the way we work and grow.... ...and career development. Summary As a Business Analyst - Claims Adjudication / Financial at Gainwell, you can contribute your skills as we harness...FinancialClaimsFull timeRemote workFlexible hours$44.5k - $63.5k
.... As an Early Career Business Analyst - Operations at Gainwell... ...of medical payments to claims, based on both paper and electronic... ...and pharmacy claims adjudication , Medicaid reclamation... ...Finance or similar enterprise financial systems. Experience...FinancialClaimsFull timeRemote workFlexible hours$23 per hour
...W e are seeking a Pharmacy Adjudication Specialist for our Specialty... ...Specialist will adjudicate pharmacy claims, review claim responses for... ...to patients regarding financial responsibility prior to shipments... ...in the Company's Code of Business Conduct and Ethics, its...FinancialClaimsFull timeTemporary workRemote workFlexible hoursShift work- ..., a Gainwell Company, is seeking an Early Career Operations Business Analyst to join a healthcare payments team. You will post payments,... ...from contiguous US locations. You’ll work with clinical and financial data, analyze discrepancies, document requirements, and support...FinancialClaimsRemote job
- ...success, the Product Manager Analyst must possess the following attributes... ...Do Actively manage financial performance of product lines... ...of customer and voice of business on NPD core teams and lead... ...product offerings, performance claims, overall market positioning and...FinancialClaimsWork at office
- ...Summary This National Guard position is for a FINANCIAL MANAGEMENT ANALYST, Position Description Number D2513P01 and is part of the OH 180... ...transcripts or other documentation to support your educational claims. To receive credit for education, you must provide...FinancialClaimsPermanent employmentFull timeContract workTemporary workPart timeWork at officeImmediate startTrial period
$69.4k - $99.2k
Senior Medicaid Business Analyst (Configuration & Policy) Great companies need great teams to... ...domains may include Member, Provider, Claims (Medicaid, Dental and/or Pharmacy), Finance... ...: Edits, pricing, benefit limits, adjudication logic Plan: Contracts, benefits,...ClaimsFull timeRemote workFlexible hours$250k - $350k
...for an ambitious, results-driven attorney seeking significant financial upside, professional autonomy, and a meaningful role in building... ...stakes disputes involving: Insurance bad faith and wrongful claim denials Fire losses, property damage, and catastrophic...FinancialClaims- ...Financial Planning Analyst Location US-OH-Dayton ID 2026-4368 Category Process Management / Liaison... ...improvements. They will also facilitate business analytic data aggregation,... ...Qualifications: Active TS clearance with SCI adjudication Bachelor's in business...FinancialFull timeContract workFor contractors
$177.5k - $222.5k
...Director, Product (Pharmacy Claims Platform) who brings deep experience... ...developing pharmacy claims adjudication technology, understands how... ...with engineering and business teams to set product direction... ..., pharmacies, clients, and financial outcomes. We're looking for...FinancialClaimsFlexible hours- ...customer engagement measures, and business objectives. Use performance... .../denials, coding, billing, claims, benefit design, and patient... ...verification, claim adjudication, or pharmaceutical/biotechnology... ...staff and eligible dependents, financial plans with opportunities to...FinancialClaimsWork at officeLocal areaRemote workWork from homeFlexible hours
- ...pivotal in overseeing core PBM functions, including claims adjudication, pharmacy network contracting, formulary... ...in a relevant field. Strong knowledge of PBM business models, healthcare regulatory compliance, and financial acumen is essential. The ideal candidate will...FinancialClaims
$113.7k - $162.4k
...development, and pharmacy point-of-sale (POS) claims processing. This position requires a... ...to success in this role. Conduct financial analyses using drug pricing, utilization... ...management, prior authorization, claims adjudication, and pharmacy benefit operations. ~ Experience...FinancialClaimsFull timeRemote workFlexible hours$113k - $197.7k
...Summary: The Director, Claims Process Optimization... ...effort, building the business case, guiding delivery... ...assigned claims adjudication and adjustment workflows... ...leads a team of managers, analysts, and process... ...auto-adjudication rate, financial and procedural accuracy...FinancialClaimsHourly payWork experience placementWork at office$103.89k - $192.19k
...disputes. The role provides financial tracking and data-driven decision... ...the potential impact to business leaders ~ Performs... ...ensure the integrity of dispute, claims, and contract data ~ Other... ..., fee schedules, claims adjudication, remittance and EOB data, and...FinancialClaimsContract workTemporary workWork at officeRemote workFlexible hours$19 - $26.4 per hour
...customer bills and insurance claims in an accurate and timely... ...to build relationships with business unit management and become "... ...Perform prescription claims adjudication including communication with... ...be treated." Compensation & Financial Competitive pay 401(k) with...FinancialClaimsHourly payFull timeTemporary workWork at officeMonday to FridayFlexible hours- ....8. Submits, reviews, and handles all adjudicated prescription claims to ensure appropriateness of reimbursement, co-pay and related financials and, if needed, follows up all such claims... ...and/or experience in the fields of business administration, sales, marketing,...FinancialClaimsMonday to FridayWeekend work
- ...The role focuses on accurate and timely processing of insurance claims, client billing, payment posting, and account reconciliation to... ...staff to resolve discrepancies, follow up on outstanding claims, and maintain timely financial reporting. #J-18808-Ljbffr TPC WellnessFinancialClaims
- ...billings to the appropriate party and follow-up for adjudication and payment of individual claims. Communicate with patients, third party payors, guarantors... ...-Works with patients/families to advise of potential financial responsibility. -Notifies payors of patient elections...FinancialClaimsDaily paidFull timeLocal areaRemote workShift work
$51.9k - $74.2k
...their operations. Join the group that solves business challenges and enhances the way we work... ...grow. As a SSRS/SSIS Reporting Business Analyst at Gainwell, you can contribute your... ...solutions. Healthcare, Medicaid, pharmacy, claims, or government program experience preferred...ClaimsFull timeRemote workFlexible hours$69.4k - $95k
...their operations. Join the group that solves business challenges and enhances the way we work... .... Summary As a Senior Business Analyst at Gainwell, you can contribute your skills... ...with healthcare, Medicaid, Medicare, claims, eligibility, or other highly regulated environments...ClaimsFull timeRemote workFlexible hours$90k - $115k
...Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Remote Liability Claims Examiner | General Liability Exp. Required Are you... ...brands? Apply your knowledge and experience to adjudicate complex customer claims in the context of an...FinancialClaimsFull timeLocal areaRemote workFlexible hours$1,000 - $2,000 per month
...difference. What You'll Do: The Business Development Director, reporting... ...enhance Connections’ market position. Financial Analysis Support : Collaborate with finance... ...you receive a suspicious communication claiming to represent Connections Health...FinancialClaimsFull timeTemporary workPart timeImmediate startRemote workFlexible hours- ...Financial Reporting Specialist Ensure accurate financial reporting, focusing on special... ...Support financial reporting and analysis, claims, audits and other external reporting and... ...projects and analyses supporting business needs and improvements. Perform detailed...FinancialClaims
$51.9k - $74.2k
...their operations. Join the group that solves business challenges and enhances the way we work... ...As a SSRS/SSIS Reporting Business Analyst at Gainwell, you can contribute your skills... ...solutions. Healthcare, Medicaid, pharmacy, claims, or government program experience...ClaimsFull timeRemote workFlexible hours$20 - $25 per hour
...Farm Agent, you are vital to our daily business operations and customers' success. You grow... ...and inquiries, processing insurance claims and following up with customers on claim... ....00 per hour This busy insurance and financial services office has a passion to make a...FinancialClaimsHourly payFor contractorsWork at office$16.3 - $25.74 per hour
...understanding how an insurance payer adjudicates claims, how to successfully work a patient’s... ...with external customers and internal business partners. The Coordinator, Collections... ...e.g. Athena, G4 Centricity, Unlimited Financials, etc.) and Microsoft Office Suite, PowerBI...FinancialClaimsHourly payFull timeTemporary workWork experience placementWork at officeLocal areaImmediate startRemote workFlexible hours$10k
...companies are subsidiaries of American Financial Group. We combine a "small company" culture... ...the entrepreneurial spirit of a growing business. Through our specialized insurance... ...one another. The Senior Medical Only Claims Representative is responsible for investigating...FinancialClaimsFull timePart timeSeasonal workRemote work$35.5 - $53.25 per hour
...reporting and decision-making. Works with IT consultancy and business units to develop and understand the business case and business... ...configuration, cost transparency, planning, reporting, and related financial management activities. Ability to assess Apptio enhancements,...FinancialDaily paidFull timeTemporary workPart timeWork at officeRemote workRelocationMonday to FridayFlexible hoursShift work- Software Guidance & Assistance, Inc., (SGA), is searching for a Senior Technical Business Analyst – Wealth & Trust Modernization for a contract assignment with one of our premier Financial Services clients in Cincinnati, OH, Farmington Hills, MI, Frisco, TX or...FinancialContract work
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