Medicaid Fraud, Waste & Abuse (FWA) Analyst

Gainwell Technologies LLC; Columbus (OH); Remote; USD 69,000 - 99,000; Full time

Benefits offered by this job

Flexible vacation policy

Educational assistance

401(k) employer match

Health benefits

Job summary

Gainwell Technologies is seeking a Senior Analyst to support state Medicaid agencies by applying FWA analytic models to Medicaid claims data and delivering monthly lead referrals. The role emphasizes producing defensible, auditable insights for OIG staff and program integrity stakeholders.

It involves presenting findings, responding to follow-ups, and contributing to investigations through data analysis and documentation.

Qualifications

• 5+ years of Medicaid claims and encounter data analysis experience.
• Deep knowledge of Medicaid program integrity, including FWA schemes and investigative workflows.
• 4+ years preparing reports documenting analytic methods and results for internal/external customers.
• Experience reading Medicaid policy, regulations, State Plan language, and related guidance.

Responsibilities

• Apply established FWA analytic models to Medicaid data to identify potential fraud, waste, and abuse.
• Deliver monthly, prequalified FWA lead referral reports on a consistent cadence.
• Produce reports that clearly articulate the analytic rationale, suspected behavior, and investigative relevance of each lead.
• Present FWA lead referrals to state Medicaid program integrity and OIG staff.
• Explain findings, methodologies, and data sources in support of state investigations.
• Respond to follow-up questions and perform supplemental or ad hoc analyses related to specific referrals.
• 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.
• Recommend enhancements, modifications, or corrections to existing analytic models.
• Translate state feedback and investigative outcomes into prioritized analytics roadmap items.
• 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.

Skills

Medicaid claims analysis

FWA program integrity

Analytic reporting

Stakeholder communication

Travel up to 25%

Job description

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

The 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.

Your role in our mission

• Apply established FWA analytic models to Medicaid claims data to identify potential fraud, waste, and abuse.
• Deliver monthly, prequalified FWA lead referral reports on a consistent and reliable cadence.
• Produce reports that clearly articulate the analytic rationale, suspected behavior, and investigative relevance of each lead.
• 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.
• Respond to follow-up questions and perform supplemental or ad hoc analyses related to specific referrals.
• 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.
• Recommend enhancements, modifications, or corrections to existing analytic models.
• Translate state feedback and investigative outcomes into prioritized analytics roadmap items.
• 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.

What we're looking for

• 5+ years of Extensive experience Analyzing Medicaid Claims and Encounter Data to Identify Fraud, Waste, and Abuse.
• 5+ years of Deep knowledge of Medicaid program integrity, including common FWA schemes, Audit Methodologies, and Investigative Workflows.
• 4+ years of Prepare reports and presentations documenting analytic methods and results for internal and external customers.
• Experience reading, interpreting, and applying Medicaid Policy, Regulations, State Plan Language, and Related Guidance.
• Strong written and verbal communication skills, with experience presenting analytic findings to state agencies, Offices of Inspector General, or other oversight bodies.

What you should expect in this role

• Regular interaction with state Medicaid and OIG stakeholders
• Monthly delivery cadence tied to investigative operations
• Balance of independent analytical work and client-facing collaboration
• 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 December 30, 2026The 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. 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."