Program Manager Fraud, Waste and Abuse (FWA)

Gainwell Technologies; Louisiana, Northern (MO, KY); On-site; USD 97,000 - 138,000; Full time

Benefits offered by this job

Remote-based role

Travel 0-25%

Video interviews

401(k) match

Health benefits

Educational assistance

Job summary

Gainwell Technologies seeks a Program Manager for Fraud, Waste and Abuse (FWA) to lead design, implementation, and continuous improvement of healthcare FWA programs.

The role translates regulatory and operational requirements into practical program documentation, leads readiness testing, and partners with analytics to develop detection strategies, dashboards, and investigations. Remote-based with potential travel.

Qualifications

• Bachelor’s degree in healthcare administration, pharmacy, nursing, business, public administration, criminal justice, information systems, analytics or related field; equivalent relevant experience may be considered.
• Eight or more years of progressively responsible experience in healthcare program management, program integrity, FWA, payment integrity, special investigations, compliance, auditing, claims operations, or related discipline.

Responsibilities

• Lead Fraud, Waste & Abuse (FWA) and Program Integrity initiatives from strategy through implementation, ensuring regulatory compliance and operational excellence.
• Drive cross-functional collaboration to design, deploy, and optimize processes, systems, controls, and governance frameworks.
• Analyze claims, provider, member, and audit data to identify fraud trends, billing anomalies, financial risks, and recovery opportunities.
• Partner with analytics teams to develop detection strategies, business rules, dashboards, and investigative workflows.
• Oversee testing, quality assurance, and user acceptance activities to ensure solutions meet business and compliance requirements.
• Support audits and investigations through data analysis, documentation review, evidence gathering, and actionable recommendations.
• Identify operational risks and process improvement opportunities to strengthen program effectiveness and outcomes.
• Prepare executive-level reports and insights on program performance, audit findings, investigation results, and emerging risks.
• Provide leadership, mentorship, and subject matter expertise to analysts, auditors, investigators, and implementation teams.
• Serve as a trusted partner to clients, regulators, vendors, and internal stakeholders, driving accountability and continuous improvement.

Skills

Analytical thinking

Critical thinking

Facilitation

Project leadership

Written communication

Presentation skills

Education

Bachelor’s degree in healthcare administration, pharmacy, nursing, business, public administration, criminal justice, information systems, analytics

Professional certification (CFE, AHFI, CHC, CIA, PMP)

Tools

Claims analytics

Data visualization

Audit platforms

Requirements management tools

Job description

Program Manager Fraud, Waste and Abuse (FWA)

Location: Any city, LA, US, 99999

Work Mode: Virtual (Exception only)

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 Principal, FWA Program Management provides senior-level leadership for the design, implementation, and continuous improvement of healthcare fraud, waste, and abuse programs. This role translates regulatory, contractual, operational, and business requirements into practical program documentation and workflows; leads implementation readiness and user acceptance testing; identifies emerging audit and investigative trends; and supports desk and field audits. The Principal serves as a subject‑matter expert and trusted advisor across program integrity, pharmacy operations, analytics, compliance, legal, product, technology, and client teams.

Your role in our mission

• Lead Fraud, Waste & Abuse (FWA) and Program Integrity initiatives from strategy through implementation, ensuring regulatory compliance and operational excellence.
• Drive cross‑functional collaboration to design, deploy, and optimize processes, systems, controls, and governance frameworks.
• Analyze claims, provider, member, and audit data to identify fraud trends, billing anomalies, financial risks, and recovery opportunities.
• Partner with analytics teams to develop detection strategies, business rules, dashboards, and investigative workflows.
• Oversee testing, quality assurance, and user acceptance activities to ensure solutions meet business and compliance requirements.
• Support audits and investigations through data analysis, documentation review, evidence gathering, and actionable recommendations.
• Identify operational risks and process improvement opportunities to strengthen program effectiveness and outcomes.
• Prepare executive‑level reports and insights on program performance, audit findings, investigation results, and emerging risks.
• Provide leadership, mentorship, and subject matter expertise to analysts, auditors, investigators, and implementation teams.
• Serve as a trusted partner to clients, regulators, vendors, and internal stakeholders, driving accountability and continuous improvement.

What we're looking for

• Bachelor’s degree in healthcare administration, pharmacy, nursing, business, public administration, criminal justice, information systems, analytics, or a related field; equivalent relevant experience may be considered.
• Eight or more years of progressively responsible experience in healthcare program management, program integrity, FWA, payment integrity, special investigations, compliance, auditing, claims operations, or a related discipline.
• Demonstrated experience leading complex, cross‑functional implementations from requirements and design through testing, deployment, and operational transition.
• Hands‑on experience developing policies, procedures, process designs, test cases, user acceptance testing materials, audit workpapers, and executive‑level reporting.
• Working knowledge of healthcare claims, provider billing, audit methodologies, investigative practices, evidence documentation, and overpayment identification.
• Knowledge of applicable federal and state healthcare program integrity requirements, including Medicare and/or Medicaid requirements.
• Strong analytical, critical‑thinking, facilitation, project leadership, written communication, and presentation skills.
• Ability to manage multiple priorities, exercise sound judgment, protect confidential information, and work effectively with technical and nontechnical stakeholders.
• Ability to travel for field audits, client meetings, or implementation activities as business needs require.
• Experience supporting Medicaid, Medicare, managed care, pharmacy benefit management, or government healthcare programs.
• Experience with claims analytics, data visualization, audit or case‑management platforms, and structured defect or requirements‑management tools.
• Professional certification such as Certified Fraud Examiner, Accredited Health Care Fraud Investigator, Certified in Healthcare Compliance, Certified Internal Auditor, Project Management Professional, or an equivalent credential.

What you should expect in this role

• Remote‑based opportunity within the United States
• Opportunities to travel through your work (0‑25%)
• 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 9/30/2026

The pay range for this position is $96,500.00 - $137,900.00 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.