Senior Analyst - Payment Integrity Analytics
Gainwell Technologies —Texas
- $69,400 - $99,200 a year
- Full-time
- Presentation skills
- Travel
- Senior level
- Travel reimbursement
- Profit sharing
Senior Specialist, Pharmacy Systems Operations - Remote
EmblemHealth —New York, NY
- $68,040 - $118,800 a year
- Remote
- Oracle
- Microsoft Outlook
- Mid-level
8d
Contracts & Financial Analyst - Veterans Affairs & Workers' Compensation
Mercy Medical Center —Cedar Rapids, IA
- Full-time
- Hybrid work
- Hospital
- 5 years
- Office
Quick Apply
Analyst
Koniag Government Services —Washington, DC
- Full-time
- Bilingual
- Mid-level
- Office
- Paid holidays
- Health insurance
Sr Epic Resolute (Billing & Claims) Certified Analyst
UNC Health —Morrisville, NC
- $41.45 - $59.58 an hour
- Full-time
- Hybrid work
- Computer Science
- Mid-level
- 3 years
9d
Senior Director Lease Administration
Colliers International —Texas
- $126,554 - $145,000 a year
- Remote
- 7 years
- Microsoft Excel
- Bachelor's degree
- Paid parental leave
- AD&D insurance
Budget Analyst
US Farm Production and Conservation (FPAC) Business Center —Kansas City, MO
- $43,106 - $56,039 a year
- Online Application
- Hybrid work
- Background check
- Writing skills
- Pass drug screening
9d
Vulnerability Assessment Analyst
US Cybersecurity and Infrastructure Security Agency —Arlington, VA
- $85,447 - $158,322 a year
- Online Application
- Background check
- Pass drug screening
- Research
2d
IT Specialist (DATAMGT)
US Office of Inspector General —Los Angeles, CA
- $90,968 - $172,980 a year
- Online Application
- Hybrid work
- Background check
- Pass drug screening
- No experience needed
IT Specialist (Data Engineer)
US Centers for Medicare & Medicaid Services —Woodlawn, MD
- $108,173 - $158,322 a year
- Part-time
- Background check
- Customer service
- Pass drug screening
2d
Sr. Business Information Analyst
Chevron Federal Credit Union —United States
- $75,148.80 - $129,162.00 a year
- Online Application
- Remote
- Microsoft Outlook
- Computer Science
- Finance
- Health insurance
- Dental insurance
Quick Apply
10d
Senior Product Manager — Fraud, Waste & Abuse (FWA)
Codoxo —United States
- Email
- Remote
- HIPAA
- 8 years
- Product management
- Health insurance
- Dental insurance
Quick Apply

More jobs to discover

Find similar jobs that you might be interested in.

Senior Systems Specialist - Augusta, GA
OnCare Digital Assets —Augusta, GA
Must have experience with: Providing practical technical assistance for the ABB Network Platform scanner; ABB 800xA system components and advanced…
Quick Apply
Sr. Mechanic Specialist (2nd Shift)
Safecor Health —Rockford, IL
Demonstrate knowledge of machine and equipment components using proper technical terminology. Strong mechanical aptitude and troubleshooting skills.
$24.50 - $32.00 an hour
14d

I want to receive the latest job alert for senior analyst, edits | payment integrity (remote)

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

senior analyst, edits | payment integrity (remote) jobs near

Senior Analyst - Payment Integrity Analytics

Gainwell Technologies -
Texas

Apply Now

Job Details

Full-time
$69,400 - $99,200 a year

Benefits

Travel reimbursement
Profit sharing
Stock options
Paid holidays
Health insurance
Tuition reimbursement
401(k) matching
Life insurance

Qualifications

Health policy analysis
Healthcare financial misconduct investigations
Health data analysis
Data summary reports
Investigative data analysis
Healthcare billing investigations
Medicaid regulations
Medicaid
Investigative reports
Research findings presentation

Full Job Description

Senior Analyst - Payment Integrity Analytics

Date: Jun 25, 2026

Location:

Any city, TX, US, 99999

Req ID: 36087

Work Mode: Virtual (Exception only)

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 Gainwell 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.

Summary

The Payment Integrity Analytics, Senior Analyst plays a critical, client-facing role supporting state Medicaid agencies by applying existing fraud, waste, and abuse (FWA) analytic models to Medicaid claims data and delivering monthly, prequalified FWA lead referrals. This role emphasizes producing clear, defensible, and actionable intelligence that can be readily understood and operationalized by state Office of Inspector General (OIG) staff and other program integrity stakeholders.

The analyst serves as a trusted analytical partner to the state, presenting and explaining FWA leads, responding to follow-up questions, and supporting investigations through data analysis, documentation, and, when required, testimony and travel related to fraud investigations. The role also includes translating state feedback, investigative outcomes, and audit results into recommendations for analytic improvements, program integrity controls, and broader Medicaid policy or operational changes.

Your role in our mission

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 clearly articulate the analytic rationale, suspected behavior, and investigative relevance of each lead.
Ensure all 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 specific referrals.
Support investigations through documentation, exhibits, and data interpretation.
Participate in meetings, 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.

What we are looking for

Extensive experience analyzing Medicaid claims and encounter data to identify fraud, waste, and abuse. (5+ years)
Deep knowledge of Medicaid program integrity, including common FWA schemes, audit methodologies, and investigative workflows. (5+ years)
Prepare reports and presentations documenting analytic methods and results for internal and external customers (4+ years)
Experience reading, interpreting, and applying Medicaid policy, regulations, state plan language, and related guidance.
Strong written and verbal communication skills, with experience presenting analytic findings to state agencies, Offices of Inspector General, or other oversight bodies.

Preferreed qualifications

Prior experience working directly with state Medicaid agencies and/or Offices of Inspector General is strongly preferred.
Professional certifications such as Certified Professional Coder (CPC), Certified Fraud Examiner (CFE), and/or Accredited Health Care Fraud Investigator (AHFI) are preferred.

What you should expect in this role

Regular interaction with state Medicaid and OIG stakeholders
Fully remote opportunity with the option to work anywhere within the United States
Monthly delivery cadence tied to investigative operations
Balance of independent analytical work and client-facing collaboration
Occasional travel and participation in investigative or hearing-related activities (Up to 25%)
Video cameras must be used during all interviews, as well as during the initial week of orientation
The Deadline to submit applications for this posting is July 14, 2026.

The pay range for this position is $69,400.00 - $99,200.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.

Apply Now

Refine Your Search

senior analyst, edits | payment integrity (remote) jobs

Senior Analyst - Payment Integrity Analytics

Senior Specialist, Pharmacy Systems Operations - Remote

Contracts & Financial Analyst - Veterans Affairs & Workers' Compensation

Analyst

Sr Epic Resolute (Billing & Claims) Certified Analyst

Senior Director Lease Administration

Budget Analyst

Vulnerability Assessment Analyst

IT Specialist (DATAMGT)

IT Specialist (Data Engineer)

Sr. Business Information Analyst

Senior Product Manager — Fraud, Waste & Abuse (FWA)

More jobs to discover

I want to receive the latest job alert for senior analyst, edits | payment integrity (remote)

Explore jobs in more locations

Senior Analyst - Payment Integrity Analytics

Job Seeker Tools

Employer Tools

Browse

Stay Connected