Senior Quality Verification Specialist

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Date:
Oct 23, 2026

Location:

Any city, TX, US, 99999

Work Mode:
Virtual (Exception only)

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development.

Protect member and provider information through independent, second-level quality reviews using an “audit-the-auditor” approach. As a Senior Verification Specialist, you’ll reassess completed verification reviews and independently retest underlying evidence, controls, decisions, and handoffs—from intake and authentication through verification, approval, processing, communication, escalation, and closure. Your scope includes assessing member and provider interactions related to member and provider account access requests, including portal administrator access changes, and provider Electronic Funds Transfer (EFT) change requests.

You’ll report findings, communicate results, and partner with account leaders to drive people, process, and technology improvements, validate corrective actions, and guide Verification Specialists while maintaining review independence.

You will be responsible for conducting independent quality and compliance reviews of member and provider interactions involving account access requests and provider EFT change requests. This role ensures requests are handled accurately, securely, and in accordance with established procedures, confidentiality requirements, and conflict-of-interest standards.

Working closely with Compliance, Operations, Quality, Privacy, Security, and other authorized stakeholders, the reviewer evaluates end-to-end request processing, documents findings, validates corrective actions, and confirms sustained process improvements. The position serves as an objective quality resource, providing clear reporting, risk identification, and compliance guidance while maintaining independence from operational decision-making. Reviews must be completed within delegated authority, and any case in which the reviewer had direct involvement must be reassigned to another independent reviewer for evaluation and closure validation.

Serve as an independent line of defense by evaluating verification activities, identifying risks, and ensuring compliance with established policies, procedures, and controls. Your work helps protect member and provider information, strengthen operational integrity, and support regulatory compliance.

• Independently reassess completed reviews using an "audit-the-auditor" approach to evaluate the completeness, accuracy, consistency, and appropriateness of prior verification reviews, findings, decisions, and escalations. Apply random, risk-based, targeted, and retrospective review methodologies while retesting controls, documentation, decisions, and handoffs against requirements in effect at the time of processing.
• Retest verification controls to confirm completed verification activities support identity, representative authority, affiliation, and ownership requirements. Validate authentication procedures, protection of verification responses, and adherence to required call controls, scripts, disclosures, and documentation standards.
• Assess member and provider interactions related to account access requests and provider EFT changes, ensuring information accuracy, professional communication, proper authorized representative handling, complete documentation, and compliance with escalation and…