Advisor Business Analytics - Fraud, Waste & Abuse

Gainwell Technologies is committed to improving the health and well-being of vulnerable communities through innovative technology solutions. The Advisor Business Analytics - Fraud, Waste & Abuse will leverage their expertise to help clients identify and investigate healthcare fraud and abuse while enhancing the FraudCapture product.

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

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