Pharmacy Claims Analyst – Remote

Gainwell Technologies is hiring a full-time Pharmacy Post-Payment Claims Analyst to join its remote team across the United States. Offering a competitive salary range of $47,000 to $67,200 per year, this role is ideal for certified pharmacy technicians with experience in claims analysis and a strong understanding of Medicaid pharmacy payment systems.

This position plays a critical role in identifying over payments and inaccuracies in post-payment pharmacy claims, particularly within the Ohio Medicaid program. If you’re detail-oriented, analytical, and passionate about improving healthcare operations, this opportunity offers flexibility, growth, and impact.

Gainwell Technologies is a leading provider of technology solutions for healthcare programs, with a focus on Medicaid and public health services. With over 50 years of experience, Gainwell supports agencies and health plans through data-driven innovation, digital modernization, and operational excellence.

The company is known for its commitment to work flexibility, employee development, and inclusive culture. As a Pharmacy Claims Analyst, you’ll be part of a team that values collaboration, continuous learning, and meaningful contributions to healthcare improvement.

Reporting to the Claims Manager, the Pharmacy Post-Payment Claims Analyst is responsible for researching and analyzing pharmacy claims after payment to identify errors, over payments, and trends. You’ll work with pharmacy data, adjudication systems, and client policies to ensure accuracy and compliance.

This role involves direct communication with pharmacies, development of training materials, operational reporting, and workflow optimization. You’ll also support the design and implementation of new processes and systems to enhance claims management.

• Investigate Ohio Medicaid pharmacy claim over payments through post-payment audits
• Analyze pharmacy claims for completeness, accuracy, and payment determination
• Develop and update educational documents and workflows for business units
• Create, maintain, and close files in accordance with company policies
• Provide training and guidance to team members on claims and provider issues
• Interpret and analyze data to identify trends and improve revenue cycle efficiency
• Review payer contracts and reimbursement trends to suggest process improvements
• Acquire knowledge of claim adjudication systems, member/provider contracts, and client payment policies
• Respond to client requests and collaborate with internal teams to resolve issues

• Bachelor’s degree in business, audit, healthcare, or related field (preferred)
• Minimum of 2 years of experience in claims analysis, processing, benefit configuration, or QA/auditing in healthcare
• Strong understanding of pharmacy claims payment configuration processes and systems
• Proven pharmacy claims processing knowledge
• National certification as a Pharmacy Technician (CPhT)
• Ability to work independently and manage multiple tasks in a remote environment
• Strong analytical, communication, and documentation skills
• Location:
  
  Remote (any U.S. city)
• Work Mode:
  Virtual (Exception only)
• Posted Date:
  September 12, 2025
• Salary Range: $47,000 – $67,200 per year
• Contract Type:
  Full-Time, Permanent

Gainwell offers a comprehensive benefits package for salaried, full-time employees:

• Flexible vacation policy
• 401(k) employer match
• Educational assistance and professional development programs
• Access to leadership and technical development academies
• Inclusive and collaborative work culture
• 100% remote work environment

Pharmacy Claims Analysts are essential to ensuring the integrity of healthcare payment systems. In this role, your work will directly impact the accuracy of Medicaid reimbursements, reduce waste, and support compliance with state and federal regulations.

You’ll be part of a team that values precision, innovation, and continuous improvement—helping to make healthcare work better for everyone.

This role is ideal for:

• Certified pharmacy technicians with claims analysis experience
• Healthcare professionals seeking remote work with a mission-driven company
• Candidates with strong analytical and documentation skills
• Individuals passionate about Medicaid operations and pharmacy systems
• Applicants looking for career growth in healthcare technology