Remote Quality Verification Specialist

Gainwell Technologies; Texas; Remote; USD 50,000 - 72,000; Full time

Benefits offered by this job

Health benefits

401(k) match

Generous vacation policy

Educational assistance

Job summary

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.

Qualifications

• 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.

Responsibilities

• 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.

Skills

Healthcare operations experience

Decision making under authority

Privacy & security awareness

Attention to detail

Written & verbal communication

Team collaboration

Education

High school diploma or equivalent

Tools

Microsoft Office

SharePoint

Job description

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.