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Benefit Verification Specialist

Benefit Verification Specialist

Multi Recruit

1 - 6 years

3 - 7 Lacs

bengaluru

Posted:-1 days ago| Platform:

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Skills Required

medicare medicaid benefit verification specialist us healthcare insurance

Work Mode

Work from Office

Job Type

Full Time

Job Description

Were hiring a Benefits Verification Specialist with 1–4 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 specialty 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 the 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.

Requirements:-

2+ years of experience in US healthcare insurance verification.
Familiarity with payer portals (e.g., Availity, Navinet, Aetna, UHC)
Understanding of insurance types (commercial, Medicare, Medicaid, HMO/PPO, etc.)
Working knowledge of CPT codes, HCPCS, and payer-specific benefits rules
Strong attention to detail and ability to document accurately
Proficient in written 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.

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Benefit Verification Specialist