Quality Verification Specialist

Job Summary

To support compliance and quality assurance efforts, the full-time remote Quality Verification Specialist will conduct secondary reviews of verification work for member and provider account access requests, evaluate supporting evidence, and make evidence-based decisions on approvals, denials, or escalations.

Key responsibilities

• Review completed verification records and assess supporting evidence for compliance with account procedures
• Approve, deny, or escalate requests based on documented evidence while maintaining accurate case records
• Collaborate with compliance and account teams to identify issues and implement process improvements

Required qualifications

• High school diploma or equivalent
• Two or more years of experience in member or provider services, healthcare operations, or related fields
• Ability to evaluate verification work and make evidence-based decisions within delegated authority
• Working knowledge of confidential-information protection and fraud indicators
• Proficiency with Microsoft Office and case-management platforms