About this role
Lead quality assurance and regulatory execution across credentialing, recredentialing, and provider data management. Hybrid role focusing on audits, SOP development, and scalable QA programs in a healthcare/insurance environment.
Key Responsibilities
- Lead QA Specialists
- Manage credentialing audits
- Develop SOPs
- Drive regulatory process changes
- Collaborate with technology teams
Technical Overview
QA, regulatory compliance, credentialing processes, SOP documentation, regulatory trend monitoring, and collaboration with technology teams on automation/AI-enabled solutions.
Ideal Candidate
Senior QA/QA lead with healthcare or insurance credentialing experience, skilled at governance, regulatory audits, and driving process improvements; comfortable with automation and AI-enabled changes.
Must-Have Skills
Experience leading quality assurance or regulatory operations in a healthcareinsuranceor provider network environmentStrong knowledge of credentialingrecredentialingand provider data management processes
Nice-to-Have Skills
Experience supporting audits and regulatory reviewsAbility to translate findings into operational improvementsComfort partnering with technology teams to support automation and AI-enabled capabilities
Tools & Platforms
SOPsQA programsCredentialing systems
Required Skills
Quality Assurance; Regulatory compliance; Credentialing; Recredentialing; Provider data management; Audits; SOPs; Process changes; Automation; AI-enabled
Hard Skills
Quality AssuranceRegulatory complianceCredentialingRecredentialingProvider data managementAuditsSOPsStandard Operating ProceduresProcess changesAutomationAI-enabled solutionsDocumentationRegulatory trendsVendor coordinationCommunication
Soft Skills
leadershipcommunicationproblem solvinganalytical thinkingteam collaborationrisk assessment
Keywords for Your Resume
change managementquality assurance leadcredentialingprovider data managementcredentialing auditsregulatory changessopstandard operating proceduresprocess changesregulatory complianceautomationai-enabledprovider networkhealthcareinsurancehybridnew yorkbethlehembostonholmdeltravelQuality Assurance LeadCredentialingProvider data managementAuditsSOPsChange managementRegulatory complianceAutomationAI-enabledVendor coordination
Deal Breakers
Lack of experience in healthcare/insurance credentialing, No experience with credentialing audits or regulatory reviews
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