This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Provides senior level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. - Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes to ensure alignment to regulatory baseline requirements and any health plan/product team developed requirements. - Monitors regulatory sources to ensure all updates are aligned and provides recommendations for process improvements and opportunities for cost savings. - Leads coordinated development and ongoing management/interpretation review process, committee structure and timing with key partner organizations. - Interprets customer business needs and translates them into application and operational requirements. - Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals. - Codifies the requirements for system configuration alignment and interpretation where applicable. - Provides support for requirement interpretation inconsistencies and complaints. - Assists with the development of requirement solution standards and best practices while suggesting improvement processes to consistently apply requirements across states and products. - Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials. - Coordinates with relevant teams for analysis, impact and implementation of changes that impact the product. - Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes. Qualifications - At least 4 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience. - Policy/government legislative review knowledge. - Strong analytical and problem-solving skills. - Familiarity with administration systems. - Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams. - Previous success in a dynamic and autonomous work environment. Requirements - Project implementation experience (preferred). - Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA) (preferred). - Medical Coding certification (preferred). Benefits Molina Healthcare offers a competitive benefits and compensation package. Company Description Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

• Track statistics and metrics, including logins, usage (internal and external user adoption/analytics), tools, and resources • Understand the business to interpret data and feedback for creating action plans • Develop business cases to help prioritize projects • Focus on continuous improvement by analyzing data and identifying issues • Investigate and manage analytics issues with LTS • Collaborate with analytics teams to develop tools, reports, and dashboards • Generate ad hoc reports and provide data analysis as needed • Supply resources, analytics, and data while gathering requirements to support process improvement • Automate data analysis and/or gathering processes • Review survey results to determine necessary actions and changes • Create a feedback loop to share data with other teams • Proactively distribute reports and analysis to divisions and regions • Work with the team to provide analytics that highlight the value of enhancements

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 Business Analyst at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position. The Senior Professional Business Analyst will play a key role on the Advancing Interoperability and Improving Prior Authorization Processes project, serving as a bridge between the systems project team, operational leadership, and the client. This role focuses heavily on operational readiness, including evaluating, designing, and documenting staffing models and operational processes needed to support the transition to and long‑term maintenance of new prior authorization workflows. This position requires strong analytical capabilities, excellent communication skills, and experience working in environments where new technology, federal regulations, and operational processes intersect. Your role in our mission Operational Process & Readiness - Analyzes current operational workflows and designs future-state processes - Develops detailed operational staffing models, workload forecasts, and support structures to maintain new prior authorization capabilities. - Recommends changes to organizational procedures and staffing. Business Analysis & Requirements - Works closely with operations, technical teams, policy, and business owners to elicit, document, and validate requirements for process changes, system updates, and user needs. - Constructs conceptual business and data models (including process flows, volume estimates, and operational metrics) reflecting current and future operational realities. - Facilitates requirements workshops and working sessions with operational stakeholders to explore potential solutions and ensure alignment with business goals. .... your role continued Testing & Validation - Develops operationally focused test scenarios and acceptance criteria to ensure new solutions align with real-world workflows. - Participates in system and operational readiness testing; analyzes results and coordinates resolution of issues impacting business operations. - Ensures “intent of change” for operational processes is fully realized through development, testing, and implementation. Project Delivery & Support - Serves as a liaison between operations leadership and the systems team to ensure operational needs are understood and incorporated. - Provides input into system modifications needed to support operational process changes. - Supports development of transition-to-operations plans, training materials, standard operating procedures, and performance monitoring structures. - Assists in estimating effort and timelines for analysis, process design, and operational readiness activities. - Conducts or assists in Trainings for Operational Staff impacted by the project solution. What we're looking for - Six or more years of business analysis experience, including work on operations‑heavy or regulatory projects. - Bachelor’s degree or equivalent combination of education and experience. Degree in business administration, health administration, information systems, or related field preferred. - Experience with business process design and re-engineering. - Experience collaborating with operational teams, technical teams, and cross-functional project teams. - Familiarity with healthcare operations or federal regulatory implementations preferred. Other Qualifications - Strong interpersonal and facilitation skills for collaborating with operational leaders and project teams. - Excellent written and verbal communication abilities, including documentation of complex business processes. - Strong analytical, problem‑solving, and critical‑thinking skills. - Ability to present findings and recommendations to management and stakeholders. - Proficiency with business analysis tools, process modeling tools, and standard productivity software. - Ability to work effectively in a collaborative team environment. - Willingness to travel as needed. What you should expect in this role - Fully remote options from continental US locations only - Video cameras must be used during all interviews, as well as during the initial week of orientation - The deadline to submit applications for this posting has been extended until a suitable candidate is selected #LI-HC1 The pay range for this position is $69,400.00 - $89,280 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.

Ciklum is looking for a Senior Business Analyst to join our team full-time in the US . We are a custom product engineering company that supports both multinational organizations and scaling startups to solve their most complex business challenges. With a global team of over 4,000 highly skilled developers, consultants, analysts and product owners, we engineer technology that redefines industries and shapes the way people live. About the role: As a Senior Business Analyst, become a part of a cross-functional development team engineering experiences of tomorrow. STARS Performance Metrics: Completing the STARS dashboard started during the POC. This includes adding cut point predictions and adjustable stars rating predictions. The goal is to make this tool maintainable by non-technical business users. Responsibilities: - Elicit and document detailed functional and non-functional requirements from RDs and stakeholders - Create user stories, acceptance criteria, and process flow diagrams for the development team - Perform gap analysis between current RD workflows and the proposed AI-powered async model - Analyze market trends in the D2C nutrition space to inform the product roadmap - Assist in User Acceptance Testing (UAT) to ensure the final product meets clinical and business goals Requirements: - Strong analytical skills with the ability to synthesize complex clinical requirements into clear tickets - Experience in the Healthcare or Wellness sector is a major plus - Proficiency in requirement gathering techniques and documenting technical specifications - Basic understanding of AI/LLM capabilities to help define realistic product features - Excellent written and verbal documentation skills What`s in it for you? - Strong community: Work alongside top professionals in a friendly, open-door environment - Growth focus: Take on large-scale projects with a global impact and expand your expertise - Tailored learning: Boost your skills with internal events (meetups, conferences, workshops), Udemy access, language courses, and company-paid certifications - Endless opportunities: Explore diverse domains through internal mobility, finding the best fit to gain hands-on experience with cutting-edge technologies - Care: Healthcare, Basic Life Insurance, Short and Long-term disability insurance according to the Company’s Benefit Plans About us: At Ciklum, we are always exploring innovations, empowering each other to achieve more, and engineering solutions that matter. With us, you’ll work with cutting-edge technologies, contribute to impactful projects, and be part of a One Team culture that values collaboration and progress. In the US, Ciklum is growing fast—inviting experienced professionals to lead digital transformation alongside Fortune 500 clients. Be part of a company where innovation and impact go hand in hand. Want to learn more about us? Follow us on Instagram, Facebook, LinkedIn. Explore, empower, engineer with Ciklum! Interested already? We would love to get to know you! Submit your application. We can’t wait to see you at Ciklum.