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Gainwell Technologies LLC · Ohio, OH, United States
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. 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.
Medicaid Fraud, Waste & Abuse (FWA) Senior Analyst
plays a critical, client-facing role supporting state Medicaid agencies by applying existing fraud, waste, and abuse (FWA) analytic models to Medicaid claims data and delivering monthly, prequalified FWA lead referrals. This role emphasizes producing clear, defensible, and actionable intelligence that can be readily understood and operationalized by state Office of Inspector General (OIG) staff and other program integrity stakeholders.
The analyst serves as a trusted analytical partner to the state, presenting and explaining FWA leads, responding to follow-up questions, and supporting investigations through data analysis, documentation, and, when required, testimony and travel related to fraud investigations. The role also includes translating state feedback, investigative outcomes, and audit results into recommendations for analytic improvements, program integrity controls, and broader Medicaid policy or operational changes.
Apply established FWA analytic models to Medicaid claims data to identify potential fraud, waste, and abuse.
Ensure all outputs are defensible, audit-ready, and written for non-technical investigative and policy audiences.
Present FWA lead referrals to state Medicaid program integrity and OIG staff.
Explain findings, methodologies, and data sources in support of state investigations.
Support investigations through documentation, exhibits, and data interpretation.
Participate in meetings, briefings, and, as needed, provide testimony or in-person investigative support (travel may be required).
Provide structured feedback to analytics and data science teams on model performance and data quality.
Analyze outcomes of other audit programs to identify systemic program integrity vulnerabilities.
Develop data-driven recommendations related to claims adjudication processes, controls, or edits.
Advise states on potential policy, regulatory, or statutory changes to reduce FWA risk and close program gaps.
Analyzing Medicaid Claims and Encounter Data to
Identify Fraud, Waste, and Abuse .
Medicaid program integrity, including common FWA schemes, Audit Methodologies, and Investigative Workflows.
Prepare reports and presentations documenting analytic methods and results for internal and external customers.
reading, interpreting, and applying Medicaid Policy, Regulations, State Plan Language, and Related Guidance .
Monthly delivery cadence tied to investigative operations
Occasional travel and participation in investigative or hearing-related activities (Up to 25%)
Fully remote opportunity with the option to work anywhere within the United States
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 is
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. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a
We also have a variety of leadership and technical development academies to help build your skills and capabilities.
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.
Details
| Company | Gainwell Technologies LLC |
| Location | Ohio, OH, United States |
| Type | FULL TIME |
| Niche | tech |