Quality Assurance & Compliance Specialist

Gainwell Technologies is a leading provider of innovative healthcare technology solutions dedicated to improving the efficiency and effectiveness of health programs. With a strong commitment to enhancing healthcare delivery, Gainwell partners with government agencies, healthcare providers, and payers to develop and implement cutting-edge systems that support Medicaid, Medicare, and other health initiatives. The company prides itself on fostering a collaborative and inclusive work environment, emphasizing continuous learning, innovation, and career growth.

About the role

As a Quality Assurance & Compliance Specialist at Gainwell, you will play a vital role in supporting the quality assurance, contract compliance, and governance activities related to the Wisconsin Medicaid Management Information System (MMIS) contract. Your primary responsibility will be to evaluate operational performance, identify quality and compliance risks, and collaborate with various teams to implement improvements that align with contractual obligations and service excellence standards. This role requires a detail-oriented and analytical professional capable of assessing complex data, facilitating discussions, and translating findings into actionable insights to enhance operational efficiency. You will serve as a subject matter expert and escalation resource for high-risk quality issues, ensuring standardized evaluation practices across operational teams. Additionally, you will work closely with leadership and staff to maintain incident reporting systems, update standard operating procedures (SOPs), and develop corrective action plans. Your efforts will directly influence the organization’s ability to meet contractual requirements, adhere to regulations, and continuously improve service delivery. This role offers an excellent opportunity to impact operational performance positively and support a culture of quality and compliance within a dynamic, remote work environment.

Responsibilities

• Analyze objective and subjective evidence to assess quality, identify root causes, and recognize performance trends
• Provide actionable feedback to support training and process improvement initiatives
• Serve as a subject matter expert and escalation resource for complex or high-risk quality issues
• Facilitate calibration and standardized evaluation practices across operational teams
• Partner with leaders and staff to maintain and enhance incident reporting, SOPs, and corrective action plans
• Evaluate compliance with policies, contractual requirements, SLAs, laws, and regulations, and recommend corrective actions as needed
• Develop formal reports and communicate findings to leadership regarding quality, audit, and compliance performance
• Monitor changes to Wisconsin MMIS contract requirements and ensure organizational alignment
• Support continuous improvement activities to optimize operational performance and compliance standards

Requirements

• Bachelor’s degree or equivalent combination of education and relevant experience
• Three or more years of experience in quality assurance, contract compliance, operational quality, audit, or related functions
• Healthcare or insurance industry experience preferred
• Strong understanding of audit concepts, practices, and procedures
• Experience analyzing findings, identifying root causes, and recommending corrective actions
• Proficiency with business applications, operating systems, relational databases, and contact center technology (experience with Verint and CXone is a plus)
• Excellent analytical, problem-solving, communication, facilitation, and organizational skills
• Ability to manage multiple priorities, support change initiatives, and drive quality improvements

Benefits

• Competitive salary range of $47,100 to $67,300 per year, commensurate with experience and location
• Flexible, remote work environment promoting work-life balance
• Generous paid vacation and leave policies
• 401(k) employer matching program
• Comprehensive health, dental, and vision insurance plans
• Educational assistance and professional development opportunities
• Participation in leadership and technical development academies
• Inclusive and diverse workplace culture that values contributions and innovation