Benifit Verification Specialist

Benefit Verification Specialist (Health Insurance, USA)
1 - 4 yearsBengaluru, Domlur

Max Notice Period 60
Working Days 5 days/week

Review Criteria
Mandatory

    Strong Benefit/ Insurance Verifcation Specialists profile
    Mandatory (Experience 1) Must have minimum 6 months of hands-on experience in US healthcare insurance eligibility and benefits verification    Mandatory (Experience 2) Must have worked on payer portals such as Availity, NaviNet, Aetna, UHC, or equivalent.    Mandatory (Experience 3) Strong understanding 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)    Manadatory (Skills) - Good communication skills

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     Which payer portals have you worked on (e.g., Availity, NaviNet, Aetna, UHC, etc.)    Rate Communication Skills (Out of 5)

Role & Responsibilities

Were hiring a Benefits Verification Specialist with 14 years of experience in US health insurance eligibility and benefits verification. Youll 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.