Review Criteria
Mandatory
- Strong Benefit/ Insurance Verifcation Specialists profile
- Mandatory (Experience 1) Must have 4+ years of experience in US healthcare insurance eligibility and benefits verification
- Mandatory (Experience 2) Must have 2+ years of experience of handling team
- Mandatory (Experience 3) Must have Strong understanding (Subject matter expert) of insurance types Commercial, Medicare, Medicare Advantage, Medicaid, Managed Medicaid, HMO/PPO, VA, DoD, etc.
- Mandatory (Experience 4) Experience in verifying deductibles, co-pay/coinsurance, prior authorization requirements, network status, and J-code/CPT/HCPCS-specific benefits.
- Mandatory (Experience 5) Ability to accurately document benefit details and maintain data in internal systems (CRM, RCM, or EMR platforms)
- Mandatory (Experience 6) Must have worked on payer portals such as Availity, NaviNet, Aetna, UHC, or equivalent.
- Manadatory (Skills) - Good communication skills
Preferred
- Preferred (Experience) Prior experience in specialty pharmacy, oncology, infusion therapy, or behavioral health benefit verification.
Job Specific Criteria
- CV Attachment is mandatory
- Are you comfortable working 5 days WFO, including rotational night shifts (5:30 PM 6:50 AM IST)
- How many years of experience do you have in US healthcare insurance eligibility and benefits verification
- how many years of experience you have in leading a team
- What's the team size you have handled
Role & Responsibilities
We're hiring a Benefits Verification Specialist with 58 years of experience in US health insurance eligibility and benefits verification. You'll be part of our operations team, helping verify insurance benefits for patients receiving speciality care in the U.S.
This is a full-time, in-office role based in Bangalore, with partial overlap with US hours.
Key Responsibilities:
- Perform insurance verification and eligibility checks for commercial and government payers (e.g., Medicare, Medicare Advantage, Medicaid, Managed Medicaid, VA, DoD).
- Validate coverage details including deductibles, co-pay/coinsurance, network status, referrals, prior authorization requirements, and J-code/CPT-code specific benefits.
- Contact payer representatives via phone or payer portals as needed.
- Push back on payer based on previous experience.
- Accurately document findings in internal systems.
- Collaborate with internal teams to resolve missing or mismatched data.
- Collaborate with technology teams to improve data/systems.
- Ensure timely completion of verifications with high accuracy and within defined SLAs.
Ideal Candidate
- 4+ years of experience in US healthcare insurance verification
- Familiarity withpayer portals(e.g., Availity, Navinet, Aetna, UHC)
- Understanding ofinsurance types(commercial, Medicare, Medicaid, HMO/PPO, etc.)
- Working knowledge ofCPT codes,HCPCS, andpayer-specific benefits rules
- Strong attention to detail and ability todocument accurately
- Proficient inwritten and spoken English
Good to Have:
- Experience in specialty pharmacy, oncology, infusion therapy, or behavioral health
- Background working with RCM platforms, EMRs, or AI-based automation tools
Perks, Benefits and Work Culture
- Be part of a team solving critical problems inhealthcare automation
- High-ownership role in astartup culturewith mentorship and fast learning
- Work closely with product and engineering teams building cutting-edgeAI agents
- Contribute to improvingaccess to carefor patients across the U.S.
