Remote Prepayment FWA Operations Manager

Gainwell Technologies; Sacramento, Northern (CA, KY); Hybrid; USD 81,000 - 116,000; Full time

Benefits offered by this job

Flexible vacation

401(k) match

Health benefits

Educational assistance

Job summary

Gainwell Technologies is seeking an Manager in Prepayment Fraud, Waste, and Abuse Operations to lead and optimize FWA investigations, case management, and program integrity initiatives. You will liaise with clients, medical consultants, and compliance teams to implement regulatory changes and drive continuous improvement.

The role requires strong leadership and deep healthcare regulatory knowledge. You will oversee governance, performance metrics, and a team responsible for high-quality

Qualifications

• 5+ years in healthcare operations, program integrity, or related field.
• 2+ years of leadership managing teams.
• Strong knowledge of healthcare regulations and claims processing.
• Experience analyzing claims, provider activity, and data to identify trends.
• Proven ability to lead complex initiatives and improve processes.

Responsibilities

• Provide leadership and oversight for Prepayment FWA operations, ensuring quality and compliance.
• Develop and optimize team performance through coaching and workforce planning.
• Establish governance, documentation standards, and case review methodologies.
• Monitor performance, trends, and risks to drive data-informed improvements.
• Collaborate with clients, consultants, compliance teams, and stakeholders on regulatory changes and enhancements.

Skills

Healthcare operations

Leadership

Regulatory knowledge

Data analysis

Stakeholder management

Education

Bachelor's degree in Healthcare

Job description

Gainwell Technologies is seeking an Manager in Prepayment Fraud, Waste, and Abuse Operations to lead and optimize FWA investigations, case management, and program integrity initiatives. You will liaise with clients, medical consultants, and compliance teams to implement regulatory changes and drive continuous improvement.

The role requires strong leadership and deep healthcare regulatory knowledge. You will oversee governance, performance metrics, and a team responsible for high-quality