Research Analyst, Prepayment Fraud, Waste and Abuse- West Sacramento, CA (Hybrid)

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

As a Prepayment Fraud, Waste and Abuse Research Analyst at Gainwell, you play a critical role in supporting providers, clients, and internal stakeholders through comprehensive research, issue resolution, communication management, and operational support. Leveraging strong analytical and problem-solving skills, you investigate leads, conducting in-depth investigative research, gathering evidence, validating facts, and documenting findings that help determine whether an investigative lead warrants further action. The role includes lead interrogation, system and program knowledge to develop accurate and timely responses and serve as a trusted resource for prepayment fraud, waste and abuse support. This position requires exceptional written and verbal communication skills, sound judgment, attention to detail, and the ability to work independently while collaborating across multiple functional areas.

Your role in our mission

• Analyze, research, and resolve routine to complex inquiries related to potential fraud, waste and abuse leads, investigation of program policies, business processes, and operational procedures in relation to claiming, utilization of subject matter expertise, independent judgment, and established resources to determine appropriate resolutions or escalations.
• Gather supporting documentation, claim history, provider information, policy references, and system data needed for medical consultant review, prioritizing assignments and ensuring timely, accurate, and documented comprehensive research summaries and case documentation for decision-maker review.
• Collaborate with cross-functional teams to investigate leads, support program initiatives, facilitate escalations, and ensure consistent application of organizational policies, procedures, and regulatory requirements.
• Conduct root cause analysis to determine whether identified anomalies are the result of system defects, provider billing errors, training gaps, policy misunderstandings, or potential fraud, waste or abuse concerns. Assist with provider education activities when directed.
• Create comprehensive research summaries and case documentation for consultant review, and identify reoccurring issues, emerging patterns and opportunities for policy, training or system improvements.

What were looking for

• Three or more years of experience in healthcare operations, claims processing, provider support, customer service, research, or a related field, with Medi-Cal and fraud/waste/abuse experience preferred.
• Strong analytical, problem-solving, and organizational skills, with the ability to research complex issues, develop effective solutions, manage multiple priorities, and perform successfully in a fast-paced environment.
• Excellent written, verbal, and interpersonal communication skills, including experience collaborating with providers, clients, internal business partners, and cross-functional teams, and the ability to tailor communications to diverse audiences.
• Working knowledge of provider operations, claims processing, and customer support practices, along with proficiency in Microsoft Office applications and business systems used to research, track, and resolve inquiries.
• Experience working with business processes. Ability to assess clients business and identify improvement opportunities

What you should expect in this role

• Primarily remote work environment with occasional onsite attendance for meetings, special projects, or other business needs. The office is located in West Sacramento, California.
• Reliable high-speed internet connectivity is required for work-from-home assignments.
• Opportunity to support critical provider and client operations while contributing to continuous improvement efforts that enhance service delivery and program effectiveness.
• The deadline to submit applications for this posting is October 15, 2026

The pay for this position is $70,304.00 per year. 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.