Manager – Prepayment Fraud, Waste, and Abuse Operations

Gainwell Technologies

. Lead and optimize Prepayment Fraud, Waste, and Abuse operations .

Posted 10/9/2026full-timeRemote • California • United StatesMid-LevelSenior💰 $81,000 - $115,700 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in leading healthcare operations focused on Prepayment Fraud, Waste, and Abuse, with a strong emphasis on compliance, performance management, and process improvement. Proven ability to analyze complex data and implement regulatory changes while fostering stakeholder relationships.

Highest-signal resume keywords

Healthcare Operations ManagementFraud, Waste, And Abuse InvestigationsClaims AnalysisRegulatory ComplianceTeam Leadership

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Claims ProcessingFraud Detection MethodologiesData AnalysisPerformance ManagementProcess ImprovementInvestigative GovernanceDocumentation StandardsWorkforce PlanningQuality AssuranceContractual Performance

Soft Skills

Analytical SkillsCommunication SkillsStakeholder ManagementRelationship BuildingProblem Solving

Industry Keywords

Program IntegrityHealthcare RegulationsBilling RequirementsOperational PerformanceCompliance TeamsMedical ConsultantsLegal RepresentativesContinuous Improvement InitiativesHigh-Risk IssuesEscalation Point

About the role

Key responsibilities & impact

Lead and optimize Prepayment Fraud, Waste, and Abuse operations
Ensure quality, productivity, timeliness, compliance, and contractual performance objectives
Lead, develop, and optimize team performance through coaching, performance management, workforce planning, training, and employee development
Serve as escalation point for complex investigations, policy interpretation, and high-risk issues
Establish and maintain investigative governance, documentation standards, and case review methodologies
Monitor operational performance, quality outcomes, investigative trends, and emerging fraud, waste, and abuse risks
Identify process gaps, mitigate risk, and drive data-informed recommendations and continuous improvement initiatives
Partner with clients, medical consultants, compliance teams, legal representatives, and other stakeholders
Lead implementation of regulatory changes, business requirements, system enhancements, and operational improvements

Requirements

What you’ll need

5+ years of experience in healthcare operations, program integrity, fraud, waste and abuse investigations, claims analysis, payment integrity, auditing, compliance, or a related healthcare field
2+ years of leadership experience managing investigative, analytical, healthcare operations, or program integrity teams
Strong knowledge of healthcare regulations, billing requirements, claims processing, fraud, waste and abuse detection methodologies, and program integrity operations
Experience analyzing claims, provider billing activity, authorization records, healthcare data, and investigative findings
Proven ability to lead complex operational initiatives, manage competing priorities, solve problems, and implement process improvements
Excellent analytical, communication, stakeholder management, and relationship-building skills
Must reside within an hour of California State Capital

Benefits

Comp & perks

Work flexibility
Learning and career development
Flexible vacation policy
401(k) employer match
Comprehensive health benefits
Educational assistance
Leadership and technical development academies