Senior Technical Business Analyst - CEF Configuration

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.

Summary

As a Senior Technical Business Analyst - CEF Configuration at Gainwell, you will serve as a hands-on technical analyst and SQL developer supporting Medicaid claims, healthcare data, and configuration-related solutions within a Maintenance & Operations environment. You will translate client requirements, Medicaid policy, operational needs, data relationships, and system-processing outcomes into technical specifications, advanced SQL solutions, custom stored procedures, validation utilities, and repeatable audit processes. This role requires advanced SQL development skills, strong technical writing, and the ability to work across business analysis and development responsibilities. The ideal candidate can independently analyze complex data and system issues, document the technical design for a custom stored procedure, develop or modify the code, validate results, and clearly communicate the solution, risks, and downstream impacts to technical and non-technical stakeholders.

Your role in our mission

Technical Analysis, SQL Development, and Solution Delivery

• Design, develop, test, document, and maintain advanced SQL queries, reusable scripts, custom stored procedures, functions, and related database utilities that support analysis, correction, auditing, troubleshooting, and reporting.
• Create developer-ready technical specifications for custom stored procedures, including purpose, scope, assumptions, source and target tables, joins, input and output parameters, processing logic, exception handling, dependencies, security considerations, performance requirements, test scenarios, and deployment or rollback considerations.
• Translate approved technical specifications into production-ready or deployment-ready SQL code in accordance with development, peer-review, source-control, testing, and release-management standards.
• Develop reusable SQL toolkits that help teams update approved fields, retrieve supporting data, combine query inputs, and reproduce or debug test cases.
• Optimize SQL solutions for accuracy, maintainability, performance, scalability, and safe execution across large Medicaid claims and healthcare datasets.
• Partner with business analysts, Advisors, database administrators, application developers, testing teams, and release teams to move solutions from requirements through implementation and post-production validation

Audit Automation and Data Quality

• Build controlled update scripts for approved, repeatable data corrections or maintenance activities, using safeguards such as pre-update checks, transaction handling, row-count verification, exception reporting, and post-update reconciliation.
• Develop automated audit and comparison processes that identify incorrect, invalid, incomplete, or missing database information across large record populations and classify exceptions for remediation.
• Produce repeatable, Excel-ready datasets and exception reports that support remediation, technical review, and audit response while reducing manual review time.
• Conduct post-implementation monitoring and reconciliation to confirm that database changes and stored procedure results satisfy the approved technical design without unintended downstream impacts.

Claims and Production Support

• Analyze and support QNXT claims-processing and healthcare data solutions across contracts, benefits, fee schedules, payment methodologies, capitation, business rules, claims adjudication logic, edits, X12 transaction data requirements, and CARC/RARC processing.
• Gainwell Technologies | Proprietary and Confidential | Senior Professional BA, CEF Claims Configuration Engineering
• Write and execute advanced SQL to analyze claims, claim lines, provider affiliations, contracts, benefits, pricing, member eligibility, edits, process steps, accumulators, encounters, remittance, and financial data.
• Perform claim-level and population-level root cause analysis for denials, pends, unexpected edits, underpayments, overpayments, duplicate conditions, encounter rejections, data-quality issues, and other processing anomalies.
• Determine whether an issue is caused by configuration, database data, stored procedure logic, policy interpretation, user processing, interface behavior, product functionality, or an upstream or downstream dependency.
• Quantify affected claims and populations, compare expected and actual results, document evidence, and recommend technically actionable corrective solutions.
• Support production incidents, client inquiries, audit requests, configuration defects, approved data fixes, custom reporting, and priority troubleshooting.

Technical Writing, Controls, and Collaboration

• Produce clear, supportable technical documentation, including SQL design documents, data mappings, table and field definitions, process flows, test cases, implementation plans, validation evidence, runbooks, and support procedures.
• Explain complex SQL logic and database findings in clear business terms, including operational impact, affected populations, risks, alternatives, and recommendations.
• Participate in requirements sessions, technical design and code reviews, defect triage, solution walkthroughs, release-readiness reviews, and knowledge-transfer activities.
• Follow established separation-of-duties, peer-review, change-control, security, and production-access requirements for database and application changes.
• Manage assigned technical work from intake and requirements clarification through design, development, testing, implementation, validation, documentation, and closure

What we're looking for

Top 3 Required Skills:

• Advanced SQL development expertise, including complex joins, subqueries, common table expressions, window functions, temporary tables, dynamic SQL, transactions, error handling, performance tuning, and custom stored procedure development.
• Demonstrated technical writing experience creating detailed, developer-ready specifications for stored procedures, database solutions, data corrections, interfaces, or similar technical components.
• Five or more years of combined education and relevant work experience in technical business analysis, SQL or database development, healthcare data analysis, systems analysis, claims processing, or a related technical discipline. Experience must demonstrate the ability to connect business requirements to database structures, technical specifications, and executable solutions

Additional required and preferred skills

• Thorough understanding of relational database concepts, normalized data models, schemas, tables, views, keys, indexing, referential integrity, and parent-child data relationships.
• Ability to create safe update scripts using transactions, validation checks, affected-row controls, rollback logic, audit logging, and reconciliation queries.
• Experience building automated audit or data-quality processes for large record populations.
• Strong knowledge of Medicaid claims processing, claims adjudication, provider reimbursement, benefits, pricing, edits, encounters, and financial processing.
• Experience analyzing X12 healthcare transactions, including 837 and 835 data and associated claim adjustment reason and remittance advice remark codes.
• Experience with SQL Server Management Studio, source control such as Git or Azure DevOps, work-tracking tools such as Jira or ServiceNow, and structured release-management practices.
• Strong analytical, problem-solving, communication, facilitation, and stakeholder-management skills.
• Relevant postsecondary education in Computer Science, Information Systems, Data Analytics, Health Informatics, Business Administration, or a related discipline may count toward the combined education and experience requirement.

What you should expect in this role

• Fully remote options from Greater Washington DC area.
• Video cameras must be used during all interviews and during the initial week of orientation.
• Work may include production support, priority issue resolution, scheduled releases, controlled data-correction activity, and coordination across multiple client and internal technical teams.
• This job description may be refined to align with the approved requisition, job profile, location, compensation, and Talent Acquisition requirements.
• Video cameras must be used during all interviews, as well as during the initial week of orientation
• Photo will be taken during screening for verification in all steps of the recruitment process.
• The deadline to submit applications for this posting is December 30, 2026

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Please ensure you join all screenings, interviews and meetings from a quiet location with a stable internet connection.

Video is required for screenings and interviews, so please test your camera and microphone in advance.

Do not use AI tools, virtual backgrounds/filters, or visual enhancements during the interview.

The pay range for this position is $69,400.00 - $99,200.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

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. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.