Quality Assurance Reviewer

Fusion Advanced Technology•Baltimore, MD

About The Position

This role involves reviewing customer, provider, case, and payment records against established QA criteria and control standards. The position supports pre-authorization reviews, tracks repeat findings, and assists with monthly reporting. It also involves escalating potential integrity issues and identifying error patterns to support operations leaders and trainers.

Requirements

Associate degree or bachelor’s degree preferred.
Three or more years of quality review, audit support, file review, claims review, eligibility review, compliance checking, or similar analytical operational experience.
3+ years total relevant experience
1+ year in QA review, compliance checking, audit support, file review, or operational quality control.

Nice To Haves

Direct public assistance, childcare subsidy, Maryland public program, or regulated operational review experience preferred.
Experience reviewing public program cases or payments for timeliness, accuracy, and policy compliance.
Experience using scorecards, review forms, or audit tools.
Experience writing concise findings and communicating them to operations teams.
Experience with Maryland systems or public program files is a plus.

Responsibilities

Review customer, provider, case, and payment records against QA criteria and control standards.
Document defects, observations, trends, and required follow-up actions clearly.
Support 100% or targeted pre-authorization reviews where required.
Track repeat findings and assist with monthly reporting and evidence preparation.
Escalate suspected integrity issues, policy deviations, or systemic problems.
Assist operations leaders and trainers by identifying error patterns and training needs.