How do we know it's truly random?

The only known explanation of what's going on in quantum mechanics is a multiversal one^[1]. Using radioactive decay of an atom as an example: there are an uncountably infinite number of universes that are initially "fungible" (identical in every way), and over time the universes gradually differentiate themselves with the atom going from a non-decayed to decayed state, at different times in each universe. But you will be in all of those universes. So if you thought the atom would decay in, let's say 5 seconds, there would be some universes where you were right and some where you were wrong. That makes it impossible to ever make reliable specific predictions about when the atom will decay. So, in practice that just looks like perfect randomness.

^[1]: There are other interpretations, of course. And those other interpretations are equally explanatory. But they do not claim to be explanations of what is actually happening to unobserved quantum particles. There is also Bohmian mechanics, but I don't know how many people take it seriously.