Job Details

Quality Assurance & Compliance Specialist - Remote US

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 As a Quality Assurance & Compliance Specialist at Gainwell, you will support quality assurance, contract compliance, and governance activities for the Wisconsin Medicaid Management Information System (MMIS) contract. You will partner with account and functional leaders to evaluate operational performance, identify quality and compliance risks, and drive improvements that support contractual requirements and service excellence. This role is ideal for a detail-oriented and collaborative quality professional who can analyze complex information, facilitate discussions, identify root causes, and translate findings into meaningful improvements.

Your role in our mission Analyze objective and subjective evidence to assess quality, identify root causes, recognize performance trends, and provide actionable feedback that supports training and process improvement. Serve as a subject matter expert and escalation resource for complex or high-risk quality issues, facilitating calibration and standardized evaluation practices across operational teams. Partner with leaders and staff to maintain and improve incident reporting, standard operating procedures (SOPs), corrective action plans, and other quality processes that support consistent execution. Evaluate compliance with policies, contractual requirements, service level agreements, laws, and regulations; identify gaps and recommend appropriate corrective actions. Develop formal reports and communicate quality, audit, compliance, and performance findings to leadership while monitoring changes to Wisconsin MMIS contract requirements.

What we're looking for 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 a related function; healthcare or insurance industry experience preferred. Experience applying audit concepts, practices, and procedures, with the ability to analyze findings, identify root causes, evaluate compliance, and recommend corrective actions. Experience working with business applications, operating systems, relational databases, and technology supporting contact center or back-office operations; experience with Verint and CXone is a plus. Strong analytical, problem-solving, communication, facilitation, and organizational skills, with experience managing multiple priorities, supporting change initiatives, and driving quality improvements.

What you should expect in this role Remote work environment requiring the ability to work independently while collaborating closely with account leaders, functional teams, and other business partners. Regular involvement in quality assurance, contract compliance, governance, audit, and continuous improvement activities supporting the Wisconsin MMIS account. Responsibility for handling sensitive and confidential information with appropriate discretion and professionalism. Fast-paced work requiring strong attention to detail, sound judgment, adaptability, and the ability to prioritize multiple quality and compliance initiatives. Opportunity to influence operational performance by identifying risks, improving processes, strengthening compliance, and helping teams consistently meet contractual and quality expectations.