Remote Medicaid FWA Analytics Lead

Gainwell Technologies; Nevada; Remote; USD 69,000 - 99,000; Full time

Benefits offered by this job

Remote work

Health benefits

401(k) match

Educational assistance

Generous vacation policy

Job summary

Gainwell Technologies seeks a Medicaid Fraud, Waste & Abuse Senior Analyst to support state Medicaid agencies by applying established analytic models to Medicaid claims data and delivering monthly, prequalified FWA lead referrals.

You will present and explain findings to state Office of Inspector General staff, respond to follow-ups, and support investigations with data analysis, documentation, and, when required, testimony and travel.

Qualifications

• 5+ years analyzing Medicaid claims and encounter data to identify fraud, waste, and abuse.
• 5+ years knowledge of Medicaid program integrity, FWA schemes, audit methodologies, and investigative workflows.
• 4+ years preparing reports documenting analytic methods and results for internal and external customers.
• Experience reading and applying Medicaid policy, regulations, state plan language, and related guidance.
• Strong written and verbal communication with state agencies or oversight bodies.

Responsibilities

• Apply FWA analytic models to Medicaid data to identify potential fraud, waste, and abuse.
• Deliver monthly prequalified FWA lead referral reports.
• Produce clear, defendable analytic outputs for non-technical audiences.
• Present referrals to state Medicaid program integrity and OIG staff.
• Explain findings and data sources to support investigations.
• Support investigations through documentation and data interpretation.
• Travel up to 25% for investigative or hearing-related activities.
• Provide feedback to analytics and data science teams on model performance.

Skills

Medicaid claims analysis

FWA identification

Client-facing

Job description

Gainwell Technologies seeks a Medicaid Fraud, Waste & Abuse Senior Analyst to support state Medicaid agencies by applying established analytic models to Medicaid claims data and delivering monthly, prequalified FWA lead referrals.

You will present and explain findings to state Office of Inspector General staff, respond to follow-ups, and support investigations with data analysis, documentation, and, when required, testimony and travel.