Medicaid Fraud, Waste & Abuse Analyst

Gainwell Technologies

. Apply established FWA analytic models to Medicaid claims data to identify potential fraud, waste, and abuse .

Posted 10/23/2026full-timeRemote • United StatesMid-LevelSenior💰 $69,400 - $99,200 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates extensive experience in analyzing Medicaid claims data to identify fraud, waste, and abuse, while effectively communicating findings and recommendations to state agencies and oversight bodies. Proficient in developing audit-ready reports and providing data-driven insights to enhance program integrity.

Highest-signal resume keywords

Medicaid Claims AnalysisFraud, Waste, And Abuse IdentificationReport Preparation And PresentationMedicaid Program Integrity KnowledgeStrong Written And Verbal Communication

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data AnalysisAudit MethodologiesInvestigative WorkflowsClaims Adjudication ProcessesAnalytic Model Enhancement

Soft Skills

Communication SkillsPresentation SkillsCollaboration

Industry Keywords

Medicaid PolicyRegulatory ComplianceProgram IntegrityFWA SchemesState Plan Language

About the role

Key responsibilities & impact

Apply established FWA analytic models to Medicaid claims data to identify potential fraud, waste, and abuse
Deliver monthly, prequalified FWA lead referral reports
Produce clear, defensible, audit-ready reports explaining analytic rationale, suspected behavior, and investigative relevance
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
Support investigations through documentation, exhibits, and data interpretation
Participate in meetings and briefings, and provide testimony or in-person investigative support as needed
Travel for fraud investigations, hearings, or related activities as required
Provide feedback to analytics and data science teams on model performance and data quality
Recommend enhancements, modifications, or corrections to analytic models
Translate state feedback and investigative outcomes into prioritized analytics roadmap items
Analyze other audit program outcomes to identify systemic program integrity vulnerabilities
Develop data-driven recommendations related to claims adjudication processes, controls, or edits
Advise states on policy, regulatory, or statutory changes to reduce FWA risk and close program gaps

Requirements

What you’ll need

5+ years of extensive experience analyzing Medicaid claims and encounter data to identify fraud, waste, and abuse
5+ years of deep knowledge of Medicaid program integrity, including common FWA schemes, audit methodologies, and investigative workflows
4+ years preparing reports and presentations documenting analytic methods and results for internal and external customers
Experience reading, interpreting, and applying Medicaid policy, regulations, state plan language, and related guidance
Strong written and verbal communication skills
Experience presenting analytic findings to state agencies, Offices of Inspector General, or other oversight bodies
Video cameras must be used during all interviews and the initial week of orientation

Benefits

Comp & perks

Work flexibility
Learning and career development
Technical credentials and certifications
Generous, flexible vacation policy
Educational assistance
Leadership and technical development academies
401(k) employer match
Comprehensive health benefits
Equal Opportunity Employer