Insurance Verification & Benefits Data Specialist

About the Role

This position calls for a committed Insurance Verification and Benefits Data Specialist to contribute to a compact operations and data unit. You will report to a founder and offer superior support to medical facilities by handling intricate tasks related to insurance eligibility, benefit confirmation, and prior authorizations. This role is ideal for detail-oriented professionals who excel in environments emphasizing data accuracy and operational efficiency. You will contribute to a culture that prioritizes technical development, rigorous documentation, and process optimization. By ensuring data integrity and conducting audits, you will serve as a key link between healthcare administration and automated workflows, contributing to the development of a highly effective remote team.

Requirements

• You must have 2 to 5 years of practical experience with US insurance verification, eligibility checks, and prior authorizations in hospital, ASC, or BPO/RCM settings, with the ability to process at least 30 verifications per day.
• You need proficiency with US-based payer portals like NaviNet, UnitedHealthcare, Availity, or Waystar, along with the capability to manage outbound phone calls to payers and document results correctly.
• You must be able to calculate patient responsibility and clearly explain insurance terms like coinsurance, deductibles, out-of-pocket maximums, and copays.
• You are required to have C1-level written English and B2-level spoken English proficiency.
• You must be available for live collaboration during the hours of 10:00 AM to 5:00/6:00 PM Pacific Time.
• You must demonstrate knowledge of PHI management and HIPAA regulations.
• It is considered an asset if you have experience with Medicare Advantage, surgical specialties, reviewing automated outputs, or utilizing advanced spreadsheets and SQL.

Responsibilities

• You will perform eligibility and benefits inquiries via American insurance portals and record key plan information such as deductibles, copays, network status, and authorization needs.
• You will save proof of each verification, such as screenshots or PDF files, and reach out to payers directly to resolve any unclear or incomplete information.
• You will oversee the full lifecycle of prior authorizations, including initial submissions, follow-up communications, and final confirmations.
• You will estimate patient financial responsibility and perform audits to compare automated system results with actual data, reporting discrepancies to the engineering staff to refine system output.
• You will uphold documentation standards, including drafting instructional guides for specific payer requirements and preparing case studies for regression testing, while maintaining a high volume of output.

Benefits & Perks

• You will receive a competitive salary and the flexibility of working entirely remotely.
• You will benefit from direct guidance from global industry specialists and have access to ongoing professional development and international networking.
• Full-time team members based in the Philippines are provided with HMO coverage starting after three months and generous paid leave according to organizational policies.
• You will be eligible for performance-based bonuses and recognition for maintaining high standards in reporting and CRM data management.