Benefit Verification Specialist (Health Insurance, USA)

Overview

This role involves verifying insurance benefits for patients receiving specialty care in the U.S., including eligibility checks, coverage validation, and payer communications. It is a full-time, in-office position based in Bangalore with partial overlap with US hours.

What You'll Do8

• 1Perform insurance verification and eligibility checks for commercial and government payers (e.g., Medicare, Medicare Advantage, Medicaid, Managed Medicaid, VA, DoD).
• 2Validate coverage details including deductibles, co-pay/coinsurance, network status, referrals, prior authorization requirements, and J-code/CPT-code specific benefits.
• 3Contact payer representatives via phone or payer portals as needed.
• 4Push back on payers based on previous experience.
• 5Accurately document findings in internal systems.
• 6Collaborate with internal teams to resolve missing or mismatched data.
• 7Collaborate with technology teams to improve data/systems.
• 8Ensure timely completion of verifications with high accuracy and within defined SLAs.

Requirements6

• 11+ years of experience in US healthcare insurance verification.
• 2Familiarity with payer portals (e.g., Availity, Navinet, Aetna, UHC).
• 3Understanding of insurance types (commercial, Medicare, Medicaid, HMO/PPO, etc.).
• 4Working knowledge of CPT codes, HCPCS, and payer-specific benefits rules.
• 5Strong attention to detail and ability to document accurately.
• 6Proficient in written and spoken English.

Who Should Apply

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