Senior Healthcare Claims Analytics Lead (Remote)

Gainwell Technologies; Mississippi; Remote; USD 69,000 - 99,000; Full time

Benefits offered by this job

Health benefits

401(k) employer match

Educational assistance

Generous vacation policy

Job summary

HMS, a Gainwell Company, is seeking a Senior Business Analyst to play a critical role in reconciling medical claims and documenting client requirements. You will work remotely across most US locations, engaging with clients to analyze data flows and improve process efficiencies in healthcare payments.

The role emphasizes SQL data extraction, understanding Medicaid adjudication, and collaboration with technical teams to translate business needs into solutions.

Qualifications

• Bachelor’s degree or 3–5 years of experience in medical claims posting and reconciliation.
• Solid understanding of medical and pharmacy claims adjudication and Medicaid reclamation claims.
• Proficiency in SQL and ability to extract and analyze data from relational databases.
• Familiarity with PeopleSoft Finance or similar enterprise financial systems.

Responsibilities

• Post payments to medical and pharmacy claims from paper and electronic EOBs daily.
• Reconcile AR and correct any 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.

Skills

SQL

Critical thinking

Written & verbal communication

Attention to detail

Education

Bachelor’s degree in Business, Healthcare Administration, Finance

Tools

PeopleSoft Finance

Relational databases

FTP protocols

Job description

HMS, a Gainwell Company, is seeking a Senior Business Analyst to play a critical role in reconciling medical claims and documenting client requirements. You will work remotely across most US locations, engaging with clients to analyze data flows and improve process efficiencies in healthcare payments.

The role emphasizes SQL data extraction, understanding Medicaid adjudication, and collaboration with technical teams to translate business needs into solutions.