Senior Quality Verification Specialist

Preferred Qualifications

• Experience in Medicaid member services or provider operations, quality reviews of member and provider interactions related to account access and provider EFT change requests, or end-to-end reviews of EFT, portal administrator access, or other high-risk provider changes. Experience with independent second-level quality reviews, risk-based sampling across roles and process stages, finding classification, root-cause analysis, corrective-action validation, cross-functional trend reporting, and recommendations for people, process, or technology improvements. Familiarity with CXone or comparable interaction-review platforms, member and provider systems of record, and business-verification tools. What you should expect in this role Fully remote options from most US locations and territories Video cameras must be used during all interviews, as well as during the initial week of orientation Photo will be taken during screening for verification in all steps of the recruitment process. The deadline to submit applications for this posting is November 12, 2026 #LI-HC1 #LI-Quality Verification Specialist Please ensure you join all screenings, interviews and meetings from a quiet location with a stable internet connection. Video is required for screenings and interviews, so please test your camera and microphone in advance. Do not use AI tools, virtual backgrounds/filters, or visual enhancements during the interview. The pay range for this position is $63,000.00 - $90,000.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits , and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities. We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings. Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.
• Experience in Medicaid member services or provider operations, quality reviews of member and provider interactions related to account access and provider EFT change requests, or end-to-end reviews of EFT, portal administrator access, or other high-risk provider changes.
• Experience with independent second-level quality reviews, risk-based sampling across roles and process stages, finding classification, root-cause analysis, corrective-action validation, cross-functional trend reporting, and recommendations for people, process, or technology improvements.
• Familiarity with CXone or comparable interaction-review platforms, member and provider systems of record, and business-verification tools.
• What you should expect in this role Fully remote options from most US locations and territories Video cameras must be used during all interviews, as well as during the initial week of orientation Photo will be taken during screening for verification in all steps of the recruitment process.
• The deadline to submit applications for this posting is November 12, 2026 #LI-HC1 #LI-Quality Verification Specialist Please ensure you join all screenings, interviews and meetings from a quiet location with a stable internet connection.
• Video is required for screenings and interviews, so please test your camera and microphone in advance.
• Do not use AI tools, virtual backgrounds/filters, or visual enhancements during the interview.
• The pay range for this position is $63,000.00 - $90,000.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.
• Put your passion to work at Gainwell.
• You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development.
• All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits , and educational assistance.
• We also have a variety of leadership and technical development academies to help build your skills and capabilities.
• We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone.
• Build your career with Gainwell, an industry leader.
• You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth.
• Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.
• Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.
• Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.