Senior Quality Verification Specialist

Job Summary

To support quality assurance efforts, the remote Senior Quality Verification Specialist will conduct independent quality reviews of member and provider interactions, reassess completed verification reviews, and validate compliance with established procedures and controls.

Key responsibilities

• Independently reassess completed verification reviews using an audit-the-auditor approach to evaluate accuracy and completeness
• Retest verification controls to confirm compliance with identity and authorization requirements
• Document findings and communicate results to leadership and stakeholders, ensuring clarity and evidence-based reporting

Required qualifications

• Five or more years of experience in member services, provider verification, compliance operations, or related fields
• Ability to independently reassess verification reviews and document objective conclusions
• Working knowledge of member and provider authentication and fraud indicators
• Strong analytical and organizational skills to prioritize high-risk work
• Proficiency with Microsoft Office and case-management systems