Quality Verification Specialist

Gainwell Technologies

. Conduct secondary reviews of completed verification work for member and provider account access requests and provider 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 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 and return incomplete or unsupported requests for correction
Record decision rationale and required next steps, obtaining separate operational, Privacy, compliance, or business-owner approvals when required
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, traceable case records, original evidence, and audit trails
Partner with compliance liaisons, account leaders, and process owners to identify recurring issues and implement improvements
Support root-cause analysis, corrective actions, procedural guidance, calibration, onboarding, training, and knowledge sharing
Recommend procedure and resource updates and refer policy questions and exceptions to designated 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 within delegated authority
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, case-management, records, and interaction platforms
Preferred: Three or more years of relevant experience
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
Ability to join screenings, interviews, and meetings from a quiet location with stable internet
Video camera required during interviews and initial orientation week

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