[Hiring] Senior Business Analyst - Pharmacy Claims @Gainwell Technologies LLC

Role Description

As a Senior Business Analyst - Pharmacy Claims 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.

• Play a critical part in ensuring Gainwell is meeting our clients’ objectives in important areas.
• 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.
• Exercise your ability to use basic analytical or relational database software — such as Excel or SQL — to quantify the anticipated impact of work.

Qualifications

• 6+ years of experience in pharmacy operations, business analysis, or pharmacy technician roles, with preferred expertise in Medicaid and Medicare programs.
• Strong understanding of pharmacy claims processing, payer systems, prior authorization workflows, and NCPDP standards.
• Testing point of sale (POS) pharmacy claims as required.
• Experience working with drug databases and file structures, including FDB, Medi-Span, and Micromedex.
• Advanced analytical and technical skills, including Excel, SQL, data analysis, requirements mapping, and system configuration concepts.
• Proven ability to solve complex business problems, improve processes, manage priorities independently, and communicate effectively with business, technical, and executive stakeholders.

Requirements

• 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 October 30, 2026.

Benefits

• 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.
• Generous, flexible vacation policy.
• 401(k) employer match.
• Comprehensive health benefits.
• Educational assistance.
• A variety of leadership and technical development academies to help build your skills and capabilities.