Remote Senior Quality Verification Specialist

Gainwell Technologies LLC; Ohio; Remote; USD 63,000 - 90,000; Full time

Benefits offered by this job

401(k) match

Health benefits

Generous vacation policy

Educational assistance

Job summary

Gainwell Technologies is seeking a Verification Specialist to conduct independent quality reviews of member and provider interactions involving account access requests and provider EFT changes. You will evaluate procedures, document findings, and recommend improvements while collaborating with Compliance, Operations, and Security teams.

The role emphasizes independence, rigorous risk assessment, and clear reporting.

Qualifications

• Five+ years of experience in member services, provider verification, or a related field.
• Experience with Medicaid member services or provider operations.
• Ability to assess end-to-end verification processes and document findings.

Responsibilities

• Conduct independent quality reviews of member and provider interactions related to account access and EFT changes.
• Evaluate documentation, controls, and handoffs across multi-step workflows.
• Identify risks, escalate critical issues, and report findings to leadership.
• Validate corrective actions and track remediation until effectiveness.

Skills

Analytical skills

Organizational skills

Time management

Communication

Quality reviews

Tools

Microsoft Office

SharePoint

Case-management systems

Job description

Gainwell Technologies is seeking a Verification Specialist to conduct independent quality reviews of member and provider interactions involving account access requests and provider EFT changes. You will evaluate procedures, document findings, and recommend improvements while collaborating with Compliance, Operations, and Security teams.

The role emphasizes independence, rigorous risk assessment, and clear reporting.