Remote Quality Verification Specialist Healthcare Compliance

Gainwell Technologies LLC; Columbus (OH); Remote; USD 50,000 - 72,000; Full time

Benefits offered by this job

Generous vacation policy

401(k) employer match

Comprehensive health benefits

Educational assistance

Job summary

Gainwell Technologies is seeking a Quality Verification Specialist to conduct secondary reviews of verification work for member/provider access requests and EFT changes. You will evaluate evidence, approve/deny/escape requests within delegated authority, and partner with compliance and account teams to resolve issues and strengthen controls.

This role emphasizes timely, evidence-based decisions, complete records, confidentiality, and clear communication.

Qualifications

• Two or more years of experience in member or provider services or related field.
• Ability to apply procedures and make evidence-based decisions within delegated authority.
• Knowledge of confidential-information protection, fraud indicators, and escalation practices.
• Strong attention to detail, judgment, organization, and time management.
• Clear written and verbal communication and collaboration across teams.

Responsibilities

• Review verification records and supporting evidence for access and EFT change requests.
• Assess identity, authority, and controls per account procedures.
• Evaluate interactions and documentation for completeness and compliance.
• Record decision rationale and ensure required approvals are obtained.
• Identify discrepancies, suspected fraud, and privacy concerns.
• Maintain secure case records and audit trails.

Skills

Attention to detail

Clear communication

Time management

Collaboration

Problem solving

Education

High school diploma

Tools

Microsoft Office

SharePoint

Case-management systems

Job description

Gainwell Technologies is seeking a Quality Verification Specialist to conduct secondary reviews of verification work for member/provider access requests and EFT changes. You will evaluate evidence, approve/deny/escape requests within delegated authority, and partner with compliance and account teams to resolve issues and strengthen controls.

This role emphasizes timely, evidence-based decisions, complete records, confidentiality, and clear communication.