Remote Credentialing Audit / Quality Control Specialist

Responsibilities :

Perform detailed quality audits on credentialing files to ensure compliance with NCQA, TJC, and organizational standards.

Review 30-40 provider files per day, verifying accuracy, completeness, and timeliness of all credentialing data.

Ensure credentialing files meet internal SLAs and quality benchmarks before submission or approval.

Conduct primary source verification (PSV) audits including education, board certifications, and state licenses.

Identify data discrepancies or process gaps and provide timely feedback and corrective guidance to credentialing team members.

Collaborate closely with offshore credentialing teams to ensure consistent quality and process alignment across time zones.

Participate in weekly team syncs (joining a team of two auditors) to review metrics, share feedback, and support ongoing process improvement initiatives.

Communicate with internal stakeholders (Credentialing, Enrollment, and Product teams) to resolve issues and enhance workflow efficiency.

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity / affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and / or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy :

Required Skills & Experience

2+ years of provider credentialing and / or payer enrollment experience, with demonstrated exposure to audit or quality review processes.

Strong understanding of NCQA and TJC standards and how they apply to credentialing and primary source verification.

Proven ability to work with offshore teams, including file handoffs, feedback loops, and remote collaboration.

Excellent organizational and communication skills with a high degree of attention to detail.

Experience meeting or exceeding daily productivity metrics (e.g., 30-40 file reviews per day).

Proficient with G-Suite (GSheets, GDocs, Gmail) and comfortable navigating credentialing platforms.

Nice to Have Skills & Experience

Background in provider enrollment or medical licensing.

Experience in a startup or fast-paced, tech-enabled environment.

Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and / or other paid time off as provided by applicable law.