Payment Integrity AI and Analytics Project Management

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 Gainwell 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 a Payment Integrity AI and Analytics Project Management, you will provide strategic and technical leadership in designing, implementing, and scaling advanced data mining and AI-enabled analytics solutions that identify improper payments and improve claims accuracy across medical, dental, and pharmacy domains.

This role blends deep healthcare payment integrity expertise, advanced data mining and AI capabilities, and principal-level delivery leadership. You will translate complex State, Federal, and client-specific reimbursement policies into scalable analytics, guide cross-functional teams through complex implementations, and ensure successful delivery of high-impact payment integrity solutions for Gainwell clients.

You will act as a content authority, product owner, and delivery leader, partnering with engineering, clinical, operations, and client teams to safeguard healthcare resources for vulnerable populations.

Your role in our mission

• Act as Product Owner, Delivery Lead, and Implementation Manager for complex data mining and analytics initiatives within the Systems Integration group.
• Design, develop, and implement advanced data mining and AI-driven analytics concepts to identify overpayments and improper payments across medical, dental, and pharmacy claims.
• Support and lead responses to client RFPs, contributing superior written content related to data mining, AI, and payment integrity capabilities.
• Translate complex healthcare regulations, reimbursement methodologies, and clinical policies into scalable audit algorithms and analytic rules.
• Research and apply CMS regulations, State and Federal guidelines, coding standards, and industry best practices to claims data and payment integrity initiatives.
• Lead the incorporation of AI, machine learning, and advanced analytics techniques (e.g., anomaly detection, predictive modeling, NLP, pattern recognition) into payment integrity solutions.
• Partner with data science and engineering teams to ensure AI solutions are explainable, auditable, compliant, and operationally scalable.
• Ensure AI-driven solutions align with regulatory requirements, client policies, and ethical AI standards.
• Act as Product Owner, Delivery Lead, and Implementation Manager for complex data mining and analytics initiatives.
• Serve as a senior mentor and subject matter expert, guiding and developing analysts, content designers, and project team members.
• Partner with clinical, operations, appeals, validation, and client services teams to resolve production issues and support ongoing audits.
• Drive continuous improvement of audit processes, analytics, and delivery methodologies.

What we're looking for

• 7+ years of Healthcare Payment Integrity, Data Mining, or Advanced Analytics experience.
• Demonstrated experience in healthcare payment integrity data mining, including validation of claims data accuracy and payment accuracy.
• Proven experience applying CMS regulations, State/Federal guidelines, coding standards, and reimbursement policies to claims analytics.
• Strong experience translating business and policy requirements into technical and analytical solutions.
• Hands-on experience with AI/ML-driven analytics, such as predictive modeling, anomaly detection, pattern recognition, or NLP applied to healthcare or financial data.
• Ability to articulate AI-driven insights clearly to technical and non-technical stakeholders.

What you should expect in this role

Opportunities to travel through your work (0-10%)
Video cameras must be used during all interviews, as well as during the initial week of orientation

The deadline to submit applications for this posting is April 30, 2026.

The pay range for this position is $108,500.00 - $155,000.00 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 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 committed to a diverse, equitable, and inclusive workplace. We are proud to be 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), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.