Senior Quality Verification Specialist

Job Summary

To support quality assurance initiatives, the full-time Senior Quality Verification Specialist will conduct independent quality reviews of member and provider interactions, ensuring compliance and accuracy in account access requests and provider Electronic Funds Transfer (EFT) changes, while working remotely.

Key responsibilities

• Independently reassess completed verification reviews using an audit-the-auditor approach to evaluate accuracy and compliance
• Retest verification controls to confirm adherence to authentication procedures and documentation standards
• Report findings and communicate results to compliance leadership and process owners, documenting risks and recommendations

Required qualifications

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