Advisor Business Analytics - Fraud, Waste & Abuse

Gainwell Technologies LLC

2d•Remote

About The Position

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at HMS, a Gainwell Company carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities. SummaryAs an Advisor Business Analytics - Fraud, Waste & Abuse at Gainwell, you may contribute your skills as we harness the power of technology to help our clients identify and investigate healthcare fraud and abuse. You will serve as a core member of the FraudCapture product team responsible for building, maintaining and enhancing our web-based SaaS solution. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position.Your role in our mission

Requirements

5+ years of SME experience leading healthcare fraud and abuse detection and investigations
2+ years of experience in requirement elicitation, analyzing and documenting business processes and system requirements that are leveraged by development teams
Curiosity to solve complex problems and strong interpersonal skills to interact with and influence clients and team members
Ability to clearly and concisely translate technical requirements to a non-technical audience
Fully Remote from Contiguous US locations only
Video cameras must be used during all interviews, as well as during the initial week of orientation
Opportunities to travel through your work for industry training, client implementation or requirements gathering (0-10%)
Work environment is a mix of client interaction, internal teamwork and individual work
Fast-paced SaaS environment

Nice To Haves

Professional certification as a Certified Fraud Examiner (CFE) or Accredited Health Care Fraud Investigator (AHFI) is desirable.

Responsibilities

Translate business needs into detailed UI mock-ups and requirements/user stories that guide development efforts
Proactively identify opportunities for system enhancements or gaps that increase product value and operational efficiency based upon new industry trends/schemes or client need
Define acceptance criteria and expected system behavior. Apply the test scenarios to execute User Acceptance Testing to verify that systems are functioning properly and business requirements are incorporated into the system design
Participate in post-deployment testing sessions that occur after normal business hours (Typically one Thursday evening every month)
Communicate effectively with both technical and non-technical audiences and capable of building and maintaining relationships with key stakeholders
Create and maintain organized product project plans through integrated management tools to support product development (i.e., Azure DevOps or other tools)
Utilize product knowledge combined with extensive Payment/Program Integrity subject matter expertise to lead requirement elicitation meetings with clients and stakeholders
Configure and tailor client system environments (rules, alerts, case workflows, etc.)
Deliver product demos, walkthroughs, and training as needed
Develop and maintain internal & client training documents, job aids, and product enhancements/release notes
Support daily product maintenance and client satisfaction