Insurance Verification & Benefits Data Specialist

This is a fully remote position, open to applicants in Philippines.

📋 Description

• Conduct eligibility and benefits verifications in US payer portals for patients with scheduled appointments.

• Document plan details, network status, deductible, out-of-pocket expenses, copay, coinsurance, and prior-authorization requirements using structured forms.

• Capture PDFs or screenshots from portals as verification evidence for each check performed.

• Indicate incomplete or conflicting portal information as unknown rather than making assumptions.

• Contact payers directly to confirm benefits when information from the portal is lacking or unclear.

• Verify whether procedures associated with CPT codes necessitate prior authorization.

• Submit prior-authorization requests and ensure follow-up until approval is received prior to the date of service.

• Document representative names, call reference numbers, and outcomes from each payer interaction.

• Adhere to client call scripts and record calls as instructed.

• Compute estimated patient responsibilities using the client’s specified formula and document the calculation process.

• Audit automated outputs against portal or call results and identify mismatches with specific explanations.

• Provide reproducible feedback to the engineering team and report patterns identified across cases.

• Create short how-to notes to document payer portal and phone peculiarities.

• Develop and maintain a curated database of verified cases across various payers and plan types for regression testing.

• Re-evaluate older cases when payer guidelines are updated.

• Generate approximately 30 new verifications daily, or perform 100–200 QA checks per day based on the task mix.

• Report directly to a founder as part of a small operations and data team.

⛳️ Requirements

• 2–5 years of practical experience in US insurance eligibility and benefits verification, as well as prior authorization in settings such as ASC, hospital, or RCM/BPO, handling a volume of over 30 verifications daily.

• Regular use of US payer portals like Availity, UnitedHealthcare, Waystar, or NaviNet.

• Experience in making outbound calls to payers for benefits verification and following up on prior authorizations, with documented call reference numbers.

• Capability to explain deductible, coinsurance, copay, and out-of-pocket maximums, along with the ability to calculate patient-responsibility estimates.

• Knowledge of HIPAA regulations and experience in handling PHI.

• Proficiency in English at C1+ CEFR level for writing and B2+ CEFR level for speaking.

• Availability for synchronous work from 10:00 AM to 5:00/6:00 PM Pacific Time.

• Experience in verification within surgical specialties like GI, ophthalmology, orthopedics, pain management, or ENT is advantageous.

• Familiarity with Medicare Advantage and secondary coverage cases is a plus.

• Experience in auditing or quality assurance of automated or AI-generated outputs is preferred.

• Knowledge of SQL, data labeling, or advanced spreadsheet capabilities is considered a plus.

• Background in working with minimal supervision, creating SOPs, or training others is a benefit.

🏝️ Benefits

• Competitive salary based on experience and skills.

• Fully remote work opportunities from anywhere in the Philippines.

• Team incentives and recognition for maintaining 100% CRM hygiene and timely reporting.

• Generous paid time off in line with company policy.

• HMO coverage available after 3 months for full-time employees located in the Philippines.

• Direct mentorship from international industry experts.

• Access to ongoing learning and development resources.

• Opportunities for global networking.