Remote Medicaid FWA Senior Analyst

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

Benefits offered by this job

Generous vacation policy

Educational assistance

Development academies

Job summary

Gainwell Technologies is seeking a Medicaid Fraud, Waste & Abuse (FWA) Senior Analyst to apply analytic models to Medicaid claims data and deliver defensible, actionable intelligence to state agencies and the OIG. This role emphasizes presenting leads, supporting investigations, and translating outcomes into policy or operational changes.

The position offers fully remote work within the United States, with travel as needed for investigations, testimony, or hearings.

Responsibilities

• Apply established FWA analytic models to Medicaid claims data to identify potential fraud, waste, and abuse.
• Present FWA lead referrals to state Medicaid program integrity and OIG staff, explaining methodologies and data sources.
• Respond to follow-up questions and support investigations through data analysis, documentation, and testimony when required.
• Translate state feedback, investigative outcomes, and audit results into recommendations for analytic improvements and program integrity controls.
• Support investigations through documentation, exhibits, and data interpretation; travel may be required.
• Provide structured feedback to analytics and data science teams on model performance and data quality.
• Analyze outcomes of other audit programs to identify systemic program integrity vulnerabilities and opportunities for process improvements.
• Develop data-driven recommendations related to claims adjudication processes, controls, or edits; advise states on policy or regulatory changes to reduce FWA risk.
• Prepare reports and presentations documenting analytic methods and results for internal and external customers; read and apply Medicaid policy, regulations, and related guidance.
• Maintain monthly delivery cadence tied to investigative operations; up to 25% travel for investigations or hearings.

Job description

Gainwell Technologies is seeking a Medicaid Fraud, Waste & Abuse (FWA) Senior Analyst to apply analytic models to Medicaid claims data and deliver defensible, actionable intelligence to state agencies and the OIG. This role emphasizes presenting leads, supporting investigations, and translating outcomes into policy or operational changes.

The position offers fully remote work within the United States, with travel as needed for investigations, testimony, or hearings.