[Hiring] Business Analyst - Medicaid Buy-In Operations @Gainwell Technologies LLC

Role Description

As a Business Analyst - Medicaid Buy-In Operations at Gainwell, you will support Medicare Buy-In operations. This subject matter expert will help Medicare-eligible members with coverage, eligibility, enrollment, and Buy-In questions.

• Answer Buy-In calls about coverage, benefits, enrollment, and eligibility.
• Clearly explain Medicare Parts A and B, Medicare Savings Programs, and Medicaid Buy-In benefits.
• Research and resolve coordination-of-benefits, eligibility, coverage, and enrollment issues.
• Document inquiries, findings, and resolutions according to procedures.
• Coordinate with members, state agencies, CMS, health plans, and internal teams.
• Interpret Medicare and Medicaid policies to resolve inquiries.
• Identify trends and process improvement opportunities.
• Help develop requirements, procedures, and training materials.
• Comply with HIPAA, CMS regulations, and Gainwell policies.

Qualifications

• 3–5+ years of Medicare and Medicaid experience.
• Comfortable assisting beneficiaries by phone.
• Understanding of coverage and eligibility rules.
• Ability to independently resolve complex inquiries with excellent service.

Requirements

• Bachelor’s degree or equivalent experience.
• At least 3 years of experience in Medicare, Medicaid, healthcare eligibility, enrollment, member services, or operations.
• Experience discussing healthcare coverage with members, beneficiaries, providers, or customers.
• Strong knowledge of Medicare Parts A and B, Medicare Savings Programs, and Medicaid.
• Excellent communication, customer service, analytical, and problem-solving skills.
• Ability to explain complex healthcare information clearly and professionally.
• Proficiency in Microsoft Office and healthcare systems.

Preferred Qualifications

• Medicare Buy-In program experience.
• Knowledge of CMS regulations, Medicare eligibility, and Medicare Savings Programs (QMB, SLMB, QI, QDWI).
• Experience with state Medicaid agencies or government healthcare programs.
• Call center, member services, or beneficiary support experience.

Benefits

• Fully remote options from most US locations and territories.
• Generous, flexible vacation policy.
• 401(k) employer match.
• Comprehensive health benefits.
• Educational assistance.
• Leadership and technical development academies to help build your skills and capabilities.

Company Description

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.