Quality Verification Specialist

Job Summary

Working remotely, the full-time Quality Verification Specialist will conduct secondary reviews of verification work for member and provider account access requests, evaluate supporting evidence, and make timely evidence-based decisions while collaborating with compliance and account teams.

Key responsibilities

• Review completed verification records and assess supporting evidence for account access and EFT change requests
• Approve, deny, or escalate requests based on documented evidence and account requirements
• Collaborate with compliance and account teams to identify recurring 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 compliance operations
• 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