Quality Verification Specialist

Gainwell Technologies LLC; Texas; Teletrabalho; USD 50 000 - 72 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Health benefits

401(k) match

Generous vacation policy

Educational assistance

Resumo da oferta

Gainwell Technologies is seeking a Quality Verification Specialist to review verification records for member and provider access requests and provider EFT changes. You’ll assess identity, authority, and controls under approved procedures and document outcomes with supporting rationale.

The role emphasizes timely, evidence-based decisions, secure records, and cross-team collaboration with CX Compliance, Privacy, and Operations.

Qualificações

• Two or more years of experience in member or provider services, provider enrollment, healthcare operations, verification, quality assurance, compliance operations, or a related field, including reviewing documentation, resolving discrepancies, or applying approval and escalation criteria.
• Ability to apply procedures, evaluate completed verification work, identify gaps, and make clear, evidence-based approval, denial, or escalation decisions within delegated authority.
• Working knowledge of confidential-information protection, fraud indicators, and escalation practices, with the ability to learn and apply account-specific identity and representative verification requirements, account access safeguards, and provider EFT controls.
• Strong attention to detail, judgment, organization, and time management to meet quality and turnaround expectations.
• Clear written and verbal communication and the ability to collaborate across compliance, quality, and account teams.
• Proficiency with Microsoft Office and SharePoint and the ability to use case-management, records, and interaction platforms.

Responsabilidades

• Review completed verification records and supporting evidence for member and provider account access requests and provider EFT change requests.
• Assess whether identity, representative authority, and required controls are adequately supported under approved account procedures.
• Evaluate submitted interactions, documentation, and verification results for completeness, consistency, and compliance.
• Approve, deny, or escape requests based on documented evidence, account requirements, and delegated authority.
• Record clear decision rationale and required next steps, and confirm that separate operational, Privacy, compliance, or business-owner approvals are obtained when required.
• Identify discrepancies, suspected fraud, and privacy or security concerns.
• Pause affected work, preserve evidence, and follow required escalation and communication protocols.
• Communicate clear outcomes, missing-information requirements, and next steps to submitting agents through approved channels for member, provider, or representative follow-up.
• Maintain accurate, secure, and traceable case records. Preserve original evidence and audit trails and follow information-access, retention, and legal-hold requirements.

Conhecimentos

Healthcare operations experience

Decision making under authority

Privacy & security awareness

Attention to detail

Written & verbal communication

Team collaboration

Formação académica

High school diploma or equivalent

Ferramentas

Microsoft Office

SharePoint

Descrição da oferta de emprego

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Quality Verification Specialist

Date: Oct 23, 2026

Location: Any city, TX, US, 99999

Work Mode: Virtual (Exception only)

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

Help protect member and provider information at Gainwell Technologies. As a Quality Verification Specialist, you’ll conduct secondary reviews of completed verification work for member and provider account access requests and provider Electronic Funds Transfer (EFT) change requests. You’ll evaluate supporting evidence and approve, deny, or escape requests within delegated authority. You’ll partner with compliance and account teams to resolve issues, strengthen controls, and improve processes across accounts.

This is a review-and-decision role; initial authentication, verification calls, and request processing remain with the responsible operational teams. You’ll be accountable for timely, evidence-based decisions, complete records, confidentiality, and clear communication. Senior Verification Specialists independently reassess review quality and validate corrective actions. The Director of Customer Experience (CX) Business Compliance provides compliance directions, and the CX Compliance Liaison coordinates cross-account improvements. You’ll collaborate with account leaders, Operations, Quality, Privacy, Security, and business owners.

Your role in our mission

• Review completed verification records and supporting evidence for member and provider account access requests and provider EFT change requests.
• Assess whether identity, representative authority, and required controls are adequately supported under approved account procedures.
• Evaluate submitted interactions, documentation, and verification results for completeness, consistency, and compliance.
• Confirm required authentication and information-protection controls were followed, and return incomplete or unsupported requests to submitting teams for correction.Approve, deny, or escape requests based on documented evidence, account requirements, and delegated authority.
• Record clear decision rationale and required next steps, and confirm that separate operational, Privacy, compliance, or business-owner approvals are obtained when required.Identify discrepancies, suspected fraud, and privacy or security concerns.
• Pause affected work, preserve evidence, and follow required escalation and communication protocols.
• Communicate clear outcomes, missing-information requirements, and next steps to submitting agents through approved channels for member, provider, or representative follow-up.
• Maintain accurate, secure, and traceable case records. Preserve original evidence and audit trails and follow information-access, retention, and legal-hold requirements.

Supporting Excellence Across the Organization

• Partner with the CX Compliance Liaison, account leaders, and process owners to identify recurring issues, support root-cause analysis, and implement approved improvements across accounts.
• Report progress and barriers while respecting account-specific requirements.
• Work with Senior Verification Specialists on procedural guidance, calibration, and quality findings.
• Complete assigned corrective actions and provide supporting evidence for independent validation.
• Route independent quality reassessment and corrective-action closure validation of work in which you materially participated to another independent reviewer.
• Support onboarding, training, and knowledge sharing initiatives across the team.
• Recommend procedure and resource updates, refer policy questions and exceptions to designated compliance authorities, and perform other authorized review support and assigned duties.

What we're looking for

• High school diploma or equivalent.
• Two or more years of experience in member or provider services, provider enrollment, healthcare operations, verification, quality assurance, compliance operations, or a related field, including reviewing documentation, resolving discrepancies, or applying approval and escalation criteria.
• Ability to apply procedures, evaluate completed verification work, identify gaps, and make clear, evidence-based approval, denial, or escalation decisions within delegated authority.
• Working knowledge of confidential-information protection, fraud indicators, and escalation practices, with the ability to learn and apply account-specific identity and representative verification requirements, account access safeguards, and provider EFT controls.
• Strong attention to detail, judgment, organization, and time management to meet quality and turnaround expectations.
• Clear written and verbal communication and the ability to collaborate across compliance, quality, and account teams.
• Proficiency with Microsoft Office and SharePoint and the ability to use case-management, records, and interaction platforms.

Preferred Qualifications

• Three or more years of relevant experience, preferably in Medicaid member or provider operations, account access review, provider EFT change review, or other high-risk request decisions.
• Experience reviewing identity, representative authority, provider applications, or financial supporting documentation, including applying account access safeguards or provider EFT controls.
• Familiarity with member and provider systems, verification tools, and secure case documentation.
• Experience with quality findings, corrective actions, root-cause analysis, training, or cross-account process improvements.

What you should expect in this role

• Fully remote options from most US locations and territories
• Video cameras must be used during all interviews, as well as during the initial week of orientation
• Photo will be taken during screening for verification in all steps of the recruitment process.

#LI-HC1

#LI-Verification Specialist

The pay range for this position is$50,400.00-$72,000.00 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 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.