Role Description As a Fraud and Abuse Review Nurse- Remote 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. - Conduct objective desk and medical record audits to verify service documentation, determine appropriate administration, and validate coding/billing accuracy. - Collaborate with internal teams (e.g., Provider Services, Contracting and Credentialing, Healthcare Services, Member Services, Claims) to collect relevant documentation for investigations. - Identify potential healthcare fraud, waste, and abuse by analyzing aberrant coding and billing patterns through utilization review. - Communicate effectively with physicians and healthcare professionals during investigations. - Prepare accurate and timely reports detailing audit findings for internal and external stakeholders. - Provide provider education on best practices (e.g., coding) based on national/local guidelines, contractual obligations, and regulatory requirements. - Identify process improvement opportunities and recommend system enhancements to optimize investigative outcomes and performance. - Data analysis of claims and utilization of benefits to identify potentially aberrant billing patterns. Qualifications - Graduate from an accredited School of Nursing. - Active, unrestricted RN license in good standing. - Preferred: Bachelor’s Degree in Nursing. Requirements - Minimum of five years of clinical nursing experience with broad clinical knowledge. - Experience in medical review and coding/billing audits for both professional and facility-based services. - Strong understanding of medical terminology, CPT, ICD-9/10, HCPCS, and DRG coding requirements. - Experience with government healthcare programs (Medicare, Medicaid, SCHIP). Benefits - Remote (work from home) environment. - Benefits on first day of employment. - 0-10% of travel. - Generous, flexible vacation policy. - 401(k) employer match. - Comprehensive health benefits. - Educational assistance. - Variety of leadership and technical development academies to help build your skills and capabilities.

• Own the analytics for Paxos-issued tokens and Rewards as a product, including defining core metrics, building dashboards, and creating analyses that inform product, rewards, and network strategy. • Translate ambiguous business questions from Product, Engineering, Finance, and Account Management into well‑scoped data problems and deliver clear, decision‑ready outputs (dashboards, analyses, memos, reports). • Partner with the data engineering team and cross-functional stakeholders to shape and improve the underlying data models in Snowflake and dbt, ensuring the stablecoin and rewards domains are well‑modeled, trusted, and documented. • Use AI‑powered tooling (e.g., Snowflake native AI, Cortex, Claude/Claude Code, Streamlit apps) to accelerate analysis, improve model quality, and prototype new analytics workflows. • Contribute to regulatory reporting, audits, and exam requests as part of the team’s BAU responsibilities, ensuring accuracy, consistency, and timely delivery.

• Own Data & Analytics Infrastructure - Centralize and structure data across DTC, retail, marketplace, paid media, subscription, operations, and finance systems - Partner cross-functionally to consolidate fragmented reporting into a scalable data warehouse and/or data lake environment - Build robust data models supporting contribution margin, cohort analysis, and channel-level performance visibility - Establish and document standardized KPI definitions across departments - Reduce reliance on manual spreadsheets and ad hoc reporting • Build Decision-Driving Dashboards & KPI Frameworks - Design and maintain executive-level dashboards in BI tools, especially Looker - Own the company-wide KPI framework, including: - Blended and channel CAC - Contribution margin by channel, product, and customer - Cohort-based LTV and payback - Marketplace and retail profitability - Inventory productivity and working capital visibility - Produce clear weekly and monthly executive summaries - Monitor leading vs. lagging indicators and proactively surface risks and opportunities • Drive Cross-Functional Performance Insights - Partner with Growth to evaluate acquisition efficiency, creative performance, and media mix effectiveness - Support Finance with revenue modeling, margin expansion analysis, and investment evaluation - Partner with Retail and Marketplace teams to assess trade spend effectiveness and promotional ROI - Analyze syndicated retail data to identify share trends, velocity shifts, distribution changes, and competitive insights - Deliver actionable recommendations that inform capital allocation and strategic trade-offs • Forecasting, Modeling & Advanced Analytics - Build and enhance financial and operational models grounded in strong business economics and unit economics principles - Support scenario planning and long-range forecasting - Develop predictive analyses such as LTV modeling, churn analysis, demand forecasting, and margin simulations - Leverage AI tools to improve forecasting accuracy, automate insight generation, and detect anomalies - Continuously elevate the analytical sophistication of the organization

• Serve as the go-to analytics partner for the VP of New Business, VP of Existing Business, VP of Partnerships, CRO, and VP RevOps, providing strategic insights and operational visibility across their books of business • Build and maintain dashboards, scorecards, and ad hoc reporting to support revenue performance tracking across new, retention, expansion, and renewal motions • Provide strategic recommendations that address identified pipeline and funnel risks and escalate actionable insights to executive stakeholders • Partner across all Revenue teams to identify, implement, and evaluate strategic growth initiatives • Drive AI alignment and development of automated insights across pipeline operations and campaign effectiveness analysis • Communicate findings, insights, and recommendations clearly and effectively across weekly, monthly, and quarterly business reviews with cross-functional stakeholders and senior leadership • Own and update headcount capacity models, territory plans, and quota allocations for the full Revenue team in alignment with GTM strategy • Partner with RevOps and Finance on compensation execution, ensuring accurate payout calculations and alignment between performance data and plan mechanic. • Deliver period-end insights and retrospectives, including performance by segment, product, and rep—along with qualitative takeaways and forward-looking recommendations • Drive proactive analytics to identify risks and opportunities before they surface, informing leadership decisions and action planning. • Manage inbound ad hoc reporting requests while maintaining focus on high-impact, scalable reporting initiatives • Support quarterly and annual planning efforts with data-backed insights that inform target-setting, revenue modeling, and resource allocation • Partner with RevOps systems team and cross-functional stakeholders to define and evolve business requirements and enable high-quality data infrastructure • Partner with Revenue team members and Data Analytics partners to support ad-hoc requests and deep dives. Enable a self-service analytics culture by driving adoption of our BI tools and dashboards to make insights consistent and accessible