Medical Insurance Verification Agent – U.S. Healthcare

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

📋 Description

• Verify patient insurance eligibility and benefits through U.S. insurance portals.

• Confirm active insurance coverage and ascertain relevant benefits and coverage details.

• Accurately capture and document verified insurance information.

• Upload necessary supporting documentation to patient records.

• Manage approximately 10–15 Verification of Benefits (VOBs) daily.

• Identify and report any discrepancies or issues with insurance coverage.

• Retrieve and download medical records from the patient management system.

• Prepare utilization review packets for submission to insurance providers.

• Submit authorization requests via email, fax, or telephone in accordance with payer requirements.

• Follow up with insurance companies regarding pending authorization requests.

• Monitor authorization expiration dates and request extensions as needed.

• Maintain comprehensive records of authorization requests, follow-ups, and their outcomes.

• Take ownership of each request from submission through to response and approval.

• Secure approvals within the required timeframes to avoid delays in patient care.

⛳️ Requirements

• Previous experience in U.S. healthcare or U.S. medical insurance is crucial.

• Exceptional English communication skills, encompassing conversational fluency, comprehension, and professional writing.

• Background in insurance verification, eligibility, benefits, authorizations, or pre-authorizations is required.

• Familiarity with U.S. insurance portals and payer processes is essential.

• Experience handling confidential medical and patient data.

• Prior Verification of Benefits (VOB) experience is necessary.

• Knowledge of Utilization Review (UR) practices is preferred.

• Experience in obtaining or following up on insurance authorizations is advantageous.

• Familiarity with behavioral health, substance use treatment, ABA, or another U.S. healthcare setting is beneficial.

• Understanding of U.S. commercial insurance and/or managed care is desired.

• A mandatory fixed fiber internet connection at the remote work location with a minimum of 25 Mbps upload and download speeds; connections such as Rain, LTE, 5G, or similar are not permitted.

• A reliable backup power solution to support equipment throughout scheduled working hours during outages is required.

• Availability Monday to Friday, from 8:00 AM to 5:00 PM EST / 2:00 PM to 11:00 PM SAST, considering daylight saving changes.

• Willingness to work on all South African public holidays is necessary.

🏝️ Benefits

• Compensation for working on South African public holidays in accordance with the Basic Conditions of Employment Act (BCEA).

• Fully remote work arrangement.