Benefit Verification Specialist (Health Insurance, USA)

Benefit Verification Specialist (Health Insurance, USA)
Full-time | Bengaluru (Domlur) | Work From Office | Rotational Night Shifts | 1–5 Years Experience

We are hiring experienced Benefit Verification Specialists for a healthtech product company working in the U.S. healthcare domain. This role requires hands-on experience in insurance eligibility and benefits verification with calling exposure to the U.S. audience.

Role Overview
You will verify patient insurance coverage with U.S. commercial and government payers, document benefit summaries accurately, and coordinate with internal teams to ensure timely processing.

Responsibilities

• Verify insurance eligibility and benefits using payer portals and phone calls
• Validate deductibles, co-pay/coinsurance, prior authorization needs, network status, J-code/CPT/HCPCS-specific benefits
• Accurately document findings in CRM/RCM/EMR platforms
• Ensure verification turnaround within defined SLAs
• Coordinate with internal teams to resolve missing or unclear data

Mandatory Requirements

• Minimum 6 months hands-on experience in U.S. healthcare eligibility and benefits verification
• Strong knowledge of insurance types: Commercial, Medicare, Medicare Advantage, Medicaid, Managed Medicaid, HMO/PPO, VA, DoD
• Proven calling experience to U.S. audience for healthcare benefits (must be visible in resume)
• Experience verifying deductibles, co-pay/coinsurance, prior authorization, network status
• Experience with CPT/HCPCS/J-code benefit checks
• Strong documentation and communication skills
• Not considering AR/accounts receivable/collections profiles

Good to Have

• Experience in specialty pharmacy, oncology, infusion therapy, behavioral health
• Experience with payer portals (Availity, NaviNet, Aetna, UHC, etc.)

Work Setup

• Work From Office, Bengaluru (Domlur)
• 5 days/week
• night shifts aligned with U.S. hours
• Maximum Notice Period accepted: 60 days

Job Type: Full-time

Pay: ₹40,000.00 - ₹50,000.00 per month

Experience:

• US audience for claims calling : 1 year (Required)

Work Location: In person