Job description

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. Summary 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. The ideal candidate has Medicare and Medicaid experience, strong analytical skills, and the ability to explain complex healthcare information clearly and compassionately. Responsibilities include answering Buy-In calls, researching eligibility and coverage issues, and coordinating resolutions with internal and external partners. Your role in our mission • 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. What we're looking for The ideal candidate has 3–5+ years of Medicare and Medicaid experience , is comfortable assisting beneficiaries by phone, understands coverage and eligibility rules, and independently resolves complex inquiries with excellent service. Skills & Competencies • Medicare and Medicaid expertise • Member support • Eligibility and enrollment analysis • Critical thinking and problem-solving • Clear verbal and written communication • Attention to detail • Empathy and professionalism • Confidential handling of sensitive healthcare information This role helps Medicare beneficiaries access and understand coverage while supporting essential state healthcare programs. Build your career with Gainwell, where collaboration, innovation, and inclusion help make healthcare work better for everyone. Required Qualifications • 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. What you should expect in this role • Fully remote options from most US locations and territories • 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 November 5, 2026 • #LI-HC1 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 $55,600.00 - $79,400.00 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.

Requirements

Must-haves

Your role in our mission
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.
Skills & Competencies
Medicare and Medicaid expertise
Member support
Eligibility and enrollment analysis
Critical thinking and problem-solving

Nice-to-haves

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.
What you should expect in this role
Fully remote options from most US locations and territories
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 November 5, 2026

Application prep

Use the role’s language and application details while tailoring your materials.

Keywords to mirror

Platform: successfactors
Effort: medium

Benefits

Benefits detected in the listing.

401(K)