Remote Operations Business Analyst – Healthcare Claims

Gainwell Technologies; Texas; Remote; USD 45,000 - 64,000; Full time

Benefits offered by this job

401(k) employer match

Health benefits

Flexible vacation policy

Educational assistance

Job summary

HMS, a Gainwell Company, is hiring an Early Career Business Analyst - Operations to support daily posting and reconciliation of medical and pharmacy claims. This fully remote role focuses on AR processes, posting accuracy, and collaboration with clients to document requirements.

The ideal candidate will have strong SQL skills, experience with healthcare claims and Medicaid reclamation, and excellent communication abilities.

Qualifications

• Bachelor’s degree in Business, Healthcare Administration, Finance, or 3–5 years in medical claims posting and reconciliation.
• Solid understanding of medical and pharmacy claims adjudication and Medicaid reclamation.
• Proficiency in SQL and ability to extract and analyze data from relational databases.
• Familiarity with PeopleSoft Finance or similar enterprise financial systems.
• Strong critical thinking and problem‑solving skills; able to troubleshoot independently.
• Experience with FTP protocols and secure file transfer.
• Excellent written and verbal communication skills.

Responsibilities

• Post payments to medical and pharmacy claims from paper and electronic EOBs daily.
• Reconcile AR and correct discrepancies or posting issues.
• Identify, analyze, and resolve errors in claim postings and payments.
• Participates in meetings with client engagement to gather and document requirements and explore potential solutions.
• Assists in analyzing and documenting client's business requirements and processes following established approach and methodology; communicate these requirements to technical personnel.
• Plans and designs standard business processes following established approach and methodology; assists in formulating recommendations to improve and support business activities.
• Develops and modifies systems requirements documentation to meet client needs.
• Generate and distribute monthly invoices using PeopleSoft Finance based on claims posted during the reporting period.
• Create, run, and deliver posting and reconciliation reports; analyze trends and anomalies.
• Use FTP protocols to securely transfer files from various sources.
• Maintain accurate documentation for audit and compliance purposes.
• Collaborate with other departments to resolve issues related to claims and payments.
• Work independently in a remote environment while meeting deadlines and service level agreements (SLAs).

Skills

SQL

Problem‑solving

Written and verbal communication

Education

Bachelor’s degree in Business, Healthcare Administration, Finance, or related field

Tools

PeopleSoft Finance

FTP protocols

Job description

HMS, a Gainwell Company, is hiring an Early Career Business Analyst - Operations to support daily posting and reconciliation of medical and pharmacy claims. This fully remote role focuses on AR processes, posting accuracy, and collaboration with clients to document requirements.

The ideal candidate will have strong SQL skills, experience with healthcare claims and Medicaid reclamation, and excellent communication abilities.