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. Summary As an Advisor Business Analytics - 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 FraudCapture 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. Your role in our mission Requirements & Product Development Support - 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) Client Engagement & Product Solution Delivery - 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 What we're looking for - 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 Certification: Professional certification as a Certified Fraud Examiner (CFE) or Accredited Health Care Fraud Investigator (AHFI) is desirable. What you should expect in this role - 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 through your work 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 deadline to submit applications for this posting is April 30, 2026 - #LI-HC1 - #LI-FWA - #LI-Healthcare Fraud and Abuse detection - #LI-RequirementsAnalysis The pay range for this position is $86,800.00 - $124,000.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at HMS, a Gainwell Company. 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 HMS, a Gainwell Company, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about HMS, A Gainwell Technologies Company at our company website and visit our Careers site for all available job role openings. HMS, a Gainwell Company, 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. HMS 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.

• Successfully acquire new enterprise sized business customers within our landmark industries in order to achieve individual quota targets. You will be required to also prospect and generate your own outbound leads. • Navigate sales cycles from value creation to negotiation and closing, and present the value of our solutions to prospective senior level customers. Build trust with C-suite and senior executives, leading strategic, high-impact conversations that uncover business priorities, align solutions to executive objectives, and drive long-term partnerships. • Take ownership of your quarterly target by crafting and executing a strategy in order to identify, generate and develop net new sales pipeline and achieve/exceed quota targets. Accurately forecast sales activity and revenue attainment. • Proactively seek out insightful market and industry information in order to effectively develop rapport with enterprise customers. Recommend relevant solutions by offering a unique product mix from the range of Hootsuite products to solve clients business challenges. Recommend appropriate third party partner solutions to meet customer needs and build a differentiated pitch for our customers. • Deliver product presentations and demos to potential customers, showcasing a range of solutions that provide maximum benefit to the customer. Complete RFI/ RFP and other supplier technical requirement documents. • Partner with our pre & post sales teams to navigate roadblocks and objections, ensuring customer success and long term value for the customer. • Based on regional needs, craft and generate expansion strategies for existing customers; present the value of our solutions to all levels of prospective customers; look for opportunities to adopt additional products and introduce sales team members to additional internal buyers for cross-sell opportunities. • Partner with Sales Development Representatives to plan approaches to your accounts and work together to build outbound pipelines. • Manage, track and report sales activities and results through Salesforce, Sales Navigator and 6Sense • Travel to see prospects and deliver presentations to stakeholders, ability to coordinate these presentations and workshops with leadership support. • Facilitate a warm handoff to the implementation and customer teams following the close of the initial customer sale to ensure a smooth customer transition and onboarding. • Perform other related duties as required.

• Successfully acquire new enterprise customers within our landmark industries in order to achieve and exceed individual quota targets. Develop and execute an industry-specific account growth strategy in order to identify, generate and develop a net new sales pipeline. • Take ownership of your quarterly target by crafting and executing a strategy in order to identify, generate and develop net new sales pipeline and achieve/exceed quota targets. Accurately forecast sales activity and revenue attainment. • Lead longer end to end sales cycles from value creation to negotiation and closing, and present the value of our solutions to senior and C-suite prospective customers. Lead strategic, high-impact conversations that uncover business priorities, align solutions to executive objectives, and drive long-term partnerships. Manage complex, global evaluations and manage stakeholders in different regions and departments. • Proactively and strategically seek out market information and understand the product-market fit in order to effectively develop rapport with customers. • As a subject matter expert in Social Media Management and in our customers unique industry, advise and recommend relevant solutions by offering a unique product mix from the range of Hootsuite products to solve clients business challenges. • Evaluate and complete RFI's/ RFP/s, Security and Privacy agreements and manage the proposal and credit review process. • Educate and inform our customers on the impact social media has on their corporate strategy. Deliver strategic product presentations, demos and supported trials of our solutions to potential customers and prospects, and identify and build consensus among multiple, cross-functional decision makers and influencers. • Partner with our pre & post sales teams as well as senior and executive internal stakeholders to remove roadblocks, create opportunity and ensure customer success and long term value for the customer. • Manage, track and report sales activities through Salesforce, Sales Navigator and 6Sense. • Based on regional needs, craft and generate expansion strategies for existing customers; present the value of our solutions to all levels of prospective customers; look for opportunities to adopt additional products and introduce sales team members to additional internal buyers for cross-sell opportunities. • Proactively transition the customer to the customer team following the close of the initial customer sale to ensure a smooth customer transition and onboarding. • Travel to see prospects and deliver presentations to stakeholders, ability to coordinate these presentations and workshops with leadership support • Lead by example to your peers and share learnings and insights with team members on deal challenges, objections, and account strategy.

Position Summary This role supports a highly specialized Medicare Secondary Payer (MSP) recovery function focused on identifying and resolving incorrect CMS/Medicare payment cases. This role performs detailed, manual case review to validate coverage responsibility, identify overpayments, and drive recovery efforts with impacted plans. Due to CMS data access and extraction limitations, the work is highly analytical and manual in nature, requiring strong judgment, documentation rigor, and deep familiarity with benefits coordination and claims recovery processes. Specific Responsibilities Medicare Secondary Payer (MSP) & Claims Recovery - Identify cases where Medicare was incorrectly designated as the primary payer. - Perform detailed, manual review of member eligibility, coverage timelines, and payment responsibility to validate recovery opportunities. - Support recovery of Medicare overpayments by coordinating accurate case documentation and tracking recovery status through resolution. - Analyze membership, billing, and CMS-related data to support payment integrity outcomes. Compliance, Documentation, & Outcome Reporting - Maintain a detailed, auditable list of all members and cases reviewed. - Track and report recovery activity. - Provide regular updates and maintain clear documentation for each active engagement to support transparency and leadership visibility into client progress and outcomes. - Ensure work meets audit and compliance requirements. - Maintain high standards of documentation accuracy and traceability given the financial and regulatory sensitivity of the work. - Develop and maintain detailed written process documentation to support training of additional resources and ensure long-term sustainability of the function. Forecasting & Capacity Planning - Deliver a written monthly forecast outlining anticipated case volume and expected recovery outputs. - Support leadership planning by providing insight into recovery trends, case complexity, and capacity constraints. - Participate in client-facing meetings and communications as needed. Skills - Strong analytical skills with the ability to perform detailed, manual case review - Claims and billing data analysis - Revenue tracking and reporting - Process documentation and workflow design - Stakeholder coordination and client communication - High attention to detail - Ability to track, report, and reconcile member and revenue data - Strong written communication and documentation skills Experience - Experience producing structured, auditable documentation and reports - Experience working in healthcare data, revenue operations, or regulatory validation environments - Demonstrated experience working with complex eligibility, coverage, and payment data - Comfort working in highly governed environments and familiarity with healthcare compliance and audit standards - Experience in Medicare Secondary Payer (MSP), payment integrity, benefits coordination, or claims recovery - Experience with CMS data, Medicare recovery processes, or healthcare overpayment recovery - Background in payment integrity, revenue recovery, or benefits administration Who We Are CAQH is the trusted data connector at the core of healthcare. For more than 25 years, we have powered the industry with the largest and most complete healthcare data foundation in the U.S., including more than 4.8 million provider data records sourced directly from providers and member data representing 75% of covered lives supplied by health plans. By improving how essential information flows across the system, CAQH helps healthcare operate more efficiently, accurately, and with greater confidence. What You Get At CAQH, you will do meaningful work at the intersection of healthcare, data, and technology, helping solve complex problems that make the healthcare system work better. You will collaborate with experienced professionals who care deeply about accuracy, trust, and meaningful impact in a fully remote environment. CAQH offers competitive compensation and a comprehensive benefits package for full-time employees, including medical, dental, and vision coverage, a 401(k) with company contributions and matching, paid parental leave, tuition assistance, and generous paid time off. We are committed to investing in our people and supporting professional growth over time. Equal Opportunity Employer CAQH is proud to be an equal opportunity employer and is committed to fostering a workplace where all individuals are valued, respected, and empowered. Employment decisions at CAQH are made without regard to race, color, religion, sex, national origin or ancestry, age, marital status, disability, protected veteran status, personal appearance, sexual orientation, gender identity or expression, familial status, family responsibilities, matriculation, political affiliation, genetic information, source of income, place of residence, or any other characteristic protected by law. CAQH does not tolerate unlawful discrimination or harassment of any kind. Applicants have rights under the Family and Medical Leave Act (FMLA), Equal Employment Opportunity (EEO), and the Employee Polygraph Protection Act (EPPA). If you need a reasonable accommodation to apply for a posted position, please contact the CAQH People & Culture team at Careers@caqh.org or 202-517-0436.