Remote Medicaid FWA Analytics Lead

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

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.