Business Analyst - Medicaid Buy-In Operations

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.