Medicaid Fraud, Waste & Abuse (FWA) Analyst

Gainwell Technologies LLC•Any city, OH

4d•$69,400 - $99,200•Remote

About The Position

The Medicaid Fraud, Waste & Abuse (FWA) Senior Analyst plays a critical, client-facing role supporting state Medicaid agencies. The analyst applies established FWA analytic models to Medicaid claims data and delivers monthly, prequalified FWA lead referrals. The work focuses on producing clear, defensible, actionable intelligence that state Office of Inspector General (OIG) staff and other program integrity stakeholders can understand and operationalize. The analyst serves as a trusted analytical partner to the state by presenting and explaining FWA leads, answering follow-up questions, and supporting investigations through data analysis, documentation, and, when required, testimony and travel. The position also translates state feedback, investigative outcomes, and audit results into recommendations for analytics improvements, program integrity controls, and broader Medicaid policy or operational changes. This is a fully remote opportunity with the option to work anywhere within the United States. The role involves regular interaction with state Medicaid and OIG stakeholders, a monthly delivery cadence, independent analytical work and client-facing collaboration, and occasional travel or participation in investigative or hearing-related activities (up to 25%). Video cameras must be used during interviews and the initial week of orientation.

Requirements

At least 5 years of experience analyzing Medicaid claims and encounter data to identify fraud, waste, and abuse.
At least 5 years of knowledge of Medicaid program integrity, including common FWA schemes, audit methodologies, and investigative workflows.
At least 4 years of experience 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.

Responsibilities

Apply established FWA analytic models to Medicaid claims data to identify potential fraud, waste, and abuse.
Deliver monthly, prequalified FWA lead referral reports on a consistent and reliable cadence.
Produce reports that explain the analytic rationale, suspected behavior, and investigative relevance of each lead.
Ensure outputs are defensible, audit-ready, and written for non-technical investigative and policy audiences.
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 related to referrals.
Support investigations through documentation, exhibits, and data interpretation.
Participate in meetings and briefings and, as needed, provide testimony or in-person investigative support; travel may be required.
Provide structured feedback to analytics and data science teams on model performance and data quality.
Recommend enhancements, modifications, or corrections to existing analytic models.
Translate state feedback and investigative outcomes into prioritized analytics roadmap items.
Analyze outcomes of other audit programs to identify systemic program integrity vulnerabilities.
Develop data-driven recommendations related to claims adjudication processes, controls, or edits.
Advise states on potential policy, regulatory, or statutory changes to reduce FWA risk and close program gaps.