Quality Verification Specialist

Gainwell Technologies

. Conduct secondary reviews of completed verification work for member and provider account access requests and provider Electronic Funds Transfer (EFT) change requests .

Posted 10/23/2026full-timeRemote • Texas • United StatesJuniorMid-Level💰 $50,400 - $72,000 per yearWebsite

About the role

Key responsibilities & impact

Conduct secondary reviews of completed verification work for member and provider account access requests and provider Electronic Funds Transfer (EFT) change requests
Evaluate supporting evidence and approve, deny, or escalate requests within delegated authority
Assess identity, representative authority, and required controls under approved account procedures
Evaluate interactions, documentation, and verification results for completeness, consistency, and compliance
Confirm authentication and information-protection controls were followed
Return incomplete or unsupported requests to submitting teams for correction
Record decision rationale and required next steps
Identify discrepancies, suspected fraud, and privacy or security concerns
Pause affected work, preserve evidence, and follow escalation and communication protocols
Communicate outcomes, missing-information requirements, and next steps to submitting agents
Maintain secure, accurate, and traceable case records, evidence, and audit trails
Partner with compliance liaisons, account leaders, and process owners on recurring issues, root-cause analysis, and approved improvements
Report progress and barriers while respecting account-specific requirements
Work with Senior Verification Specialists on procedural guidance, calibration, and quality findings
Complete corrective actions and provide evidence for independent validation
Support onboarding, training, and knowledge sharing
Recommend procedure and resource updates and refer policy questions and exceptions to compliance authorities

Requirements

What you’ll need

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
Experience reviewing documentation, resolving discrepancies, or applying approval and escalation criteria
Ability to apply procedures, evaluate completed verification work, identify gaps, and make evidence-based approval, denial, or escalation decisions
Working knowledge of confidential-information protection, fraud indicators, and escalation practices
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
Clear written and verbal communication and ability to collaborate across compliance, quality, and account teams
Proficiency with Microsoft Office and SharePoint
Ability to use case-management, records, and interaction platforms
Preferred: Three or more years of relevant experience
Preferred experience in Medicaid member or provider operations, account access review, provider EFT change review, or other high-risk request decisions
Preferred experience reviewing identity, representative authority, provider applications, or financial supporting documentation
Preferred familiarity with member and provider systems, verification tools, and secure case documentation
Preferred experience with quality findings, corrective actions, root-cause analysis, training, or cross-account process improvements

Benefits

Comp & perks

Work flexibility
Learning and career development
Flexible vacation policy
401(k) employer match
Comprehensive health benefits
Educational assistance
Leadership and technical development academies