Quality assurance specialist

Are you an experienced customer service or healthcare operations professional seeking a rewarding work-from-home role? We are looking for empathetic, detail-oriented problem solvers to join an integrated operations team as a Customer Service & Coverage Representative!

In this dynamic remote role, you will serve as a vital point of contact for Medicare members, prescribers, and healthcare providers. You will handle coverage-related requests-such as prior authorizations, coverage determinations, and drug benefit exceptions-across both phone and fax channels. Working from your home office on an assigned 8-hour shift between 7:00 AM and 8:00 PM CST (Monday through Friday, with rotating weekend coverage), you will review documentation, conduct outbound research calls, and ensure cases are resolved accurately in accordance with federal Medicare guidelines and quality standards.

If you bring strong communication skills, a high level of computer literacy, and a passion for delivering compassionate service in a fast-paced environment, this position offers an ideal platform to grow your healthcare career. We provide full modularized training to ensure you are fully equipped for success before transitioning into production work.

salary: $22.38 - $22.4 per hour
shift: First
work hours: 8 AM - 5 PM
education: High School

Responsibilities

Position Summary:

Process coverage determinations, prior authorizations, and drug benefit requests via phone and fax channels for Medicare members and prescribers while maintaining strict regulatory compliance.

Key Responsibilities:

• Review and set up incoming coverage requests, prior authorizations, and appeals from phone and fax channels.
• Conduct outbound calls to members and healthcare providers to collect missing or required case details.
• Document case activities accurately in system databases in compliance with CMS timelines and quality metrics.
• Escalate complex clinical cases or coverage inquiries to clinical pharmacists and management.

Requirements:

• High School Diploma or GED required.
• 6+ months of experience in customer service, healthcare, pharmacy, or call center operations.
• Typing speed of 30+ WPM with strong multi-system navigation skills.
• Dedicated home workspace with hardwired high-speed internet (25 Mbps download / 5 Mbps upload minimum).
• Full availability for initial 8-week mandatory training (M-F, 8:00 AM - 4:30 PM CST).

Skills

• Quality Assurance
• Quality Control
• Product Inspection

Qualifications

• Years of experience: 2 years
• Experience level: Experienced

Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad.


Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact View email address on click.appcast.io.

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.