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.
Summary
The Quality Assurance Specialist isresponsible for validating employee outputs in various areas including Claims, Member/Provider Service, Enrollment to ensure quality, accuracy, and regulatory compliance. The Quality Assurance Specialist collaborates with business partners across Operations and external vendors to create and maintain quality policies and processes to assure program meets the agreed upon standards.
Your role in our mission
- Perform quality audits on Membership eligibility and enrollment entry for accuracy and timeliness in accordance with regulatory standards and regulatory agencies.
- Prepares and maintains Quality policies and procedures.
- Conducts research, compiles and analyzes performance reports to identify the root cause of problems and recommend process improvements.
- Monitor external vendor quality, investigate discrepancies, and report errors to the appropriate operation team.
- Conduct accurate and timely quality reviews.
- Works with team members on issues found during quality reviews providing direction on the areas missed and corrections needed. Will also validate the changes requested were completed correctly.
What we’re looking for
- Experience with Medicaid processes preferred
- Self-motivated with good time management and organizational skills.
- Ability to work independently as well as with a team.
- Demonstrated competency with MS Office and MS Windows, specifically in Microsoft Excel.
- Detail oriented.
What you should expect in this role
- Must be a resident of the state of Mississippi.
- Hybrid work environment. Required to be in the office as needed for face-to-face trainings and/or meetings with the remainder of time being remote. The office is located in the Ridgeland, MS area.
- Must have reliable high-speed internet connectivity when working from home..
- Employees working-from-home may be required to report to the office, at times, to support work efforts.
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The pay range for this position is $47,100.00 – $67,300.00 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 committed to a diverse, equitable, and inclusive workplace. We are proud to be 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), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.