Medicaid Fraud, Waste & Abuse (FWA) Analyst

Gainwell Technologies LLC; Oregon; Hybrid; USD 69,000 - 99,000; Full time

Benefits offered by this job

Flexible vacation policy

Educational assistance

Leadership academies

Technical development academies

401(k) employer match

Comprehensive health benefits

Job summary

Gainwell Technologies is seeking a Senior Analyst for Medicaid Fraud, Waste & Abuse to support state Medicaid agencies by applying analytic models to claims data and delivering monthly lead referrals. This role emphasizes producing clear, defensible intelligence for OIG and program integrity stakeholders.

The analyst will present findings, respond to questions, and support investigations through data interpretation and documentation, with travel as needed. Fully remote within the United States.

Qualifications

• 5+ years analyzing Medicaid claims and encounter data for fraud, waste and abuse.
• Deep knowledge of Medicaid program integrity, FWA schemes, audit methodologies, and investigations.
• 4+ years preparing reports and presentations documenting analytic methods and results.
• Experience reading and applying Medicaid policy, regulations, and related guidance.
• Strong written and verbal communication, with experience presenting findings to state agencies.

Responsibilities

• Apply established FWA analytic models to Medicaid claims data to identify potential fraud, waste and abuse.
• Deliver monthly, prequalified FWA lead referral reports.
• Produce clear, defensible analytic reports for non-technical audiences.
• Present FWA leads to state Medicaid program integrity and OIG staff.
• Provide testimony or investigative support as needed and respond to follow-up questions.

Skills

Medicaid claims analysis

Medicaid program integrity

Analytic reporting

Policy interpretation

Stakeholder communication

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, 2026

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.

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
• educational assistance

We also have a variety of leadership and technical development academies to help build your skills and capabilities.

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."