Advisor Business Analyst - Fraud, Waste & Abuse

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.

As an Advisor Business Analyst – 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 Fraud Capture 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.

• 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 Dev Ops 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

• 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

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

• 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 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

The pay range for this position is $86,800.00 – $ per year. The base pay offered may vary depending on geographic region, internal equity, job‑related knowledge, skills, and experience among other factors. 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…