Verification & QA Specialist

Key Responsibilities

• Cross-check and verify client demographics, date of birth, contact information, and identification documents.
• Verify insurance policy numbers, coverage limits, lien information, and provider details for accuracy and completeness.
• Collect, organize, and verify medical bills, medical records, and affidavits from healthcare providers.
• Maintain accurate, well-organized records of all documentation and related communications.
• Audit CMS entries regularly to ensure all data, documents, and correspondence are complete, current, and correctly filed.
• Confirm that all signed authorizations, claims, medical records, and correspondence are properly uploaded and indexed.
• Accurately draft demand documents based on verified medical documentation in a timely manner.
• Ensure all gathered documentation and drafted demands meet internal quality standards for accuracy and completeness.
• Flag inconsistencies, missing information, or documentation gaps to case managers, legal staff, or operations leads.
• Maintain a verification and quality checklist for each case through the demand stage.
• Communicate effectively with medical providers, clients, and internal team members to resolve discrepancies and confirm information.
• Collaborate closely with legal and administrative teams to support case preparation and overall case management.

KPIs / Performance Metrics

• File accuracy audit score ≥ 99%.
• Missing or incorrect data items ≤ 1 per 50 cases audited.
• Verification and documentation completion within 48 hours of file opening (≥ 95%).
• Demand drafts completed within established turnaround timelines.
• Zero duplicate, outdated, or improperly filed data entries.