Expert Business Analyst - Healthcare Fraud Solutions

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. 

 

Summary

Are you a healthcare fraud expert who wants to make an impact by developing innovative solutions to the problems faced within the program integrity industry?

 

Gainwell is seeking a motivated, multitalented candidate with healthcare fraud expertise to fill our Advisor Business Analyst position. You will be a part of a team that builds and grows our fraud, waste and abuse (FWA) product, FraudCapture. FraudCapture is a client configurable web-based platform solution that enables our clients to efficiently identify and investigate potential fraud, waste and abuse. Our product provides clients powerful analytics, case tracking management, automated processes, ad-hoc data reporting capabilities and many other tools to assist healthcare investigators with complex healthcare investigations.

 

If you are a creative problem solver and skilled at documenting detailed business requirements to improve FWA processes, workflows and technological solutions, then consider stepping into this role on our product team. This role will combine your FWA knowledge and understanding of how investigations are conducted to help our clients detect, prevent and investigate healthcare fraud. 

 

As an Expert Business Analyst - Healthcare Fraud Solutions at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. 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

Take charge and focus on how we can meet critical needs to help clients deliver better health and human services outcomes. 

• Serves as a member of a Product team responsible for a web-based SaaS solution that provides clients the means to detect and investigate healthcare fraud, waste and abuse (FWA)
• Utilizes product knowledge combined with extensive Payment/Program Integrity subject matter expertise to lead requirement elicitation meetings with clients and stakeholders
• Proactively identifies system enhancements that increase the value of the product
• Develops detailed UI mock-ups and business requirements that guide development efforts
• Creates test scenarios and develops test plans to be used in testing the business applications in order to verify that client requirements are incorporated in to the system design
• Participates in post-deployment testing sessions that occur after normal business hours (Typically one Thursday evening every month)
• Communicates effectively with both technical and non-technical audiences and capable of building and maintaining relationships with key stakeholders

What we're looking for

Basic Qualifications

• 9+ years of experience detecting and investigating healthcare fraud or experience working on systems designed for those purposes
• 2+ years of experience in requirement elicitation, analyzing and documenting business processes and system requirements that are leveraged by development teams
• Excellent communication and interpersonal skills
• Strong analytical and problem-solving skills
• Ability to work on complex projects with general direction and minimal guidance

Desired Qualifications

• Experience with Medicaid Management Information Systems (MMIS)
• Good personal computer and business solutions software skills
• Ability to work in a team environment
• Willing to travel (10%)

Additional Expecations

• Primarily sedentary work, but does require occasional standing, walking, lifting, and moving objects (up to 10 lbs.)