Benefit/ Insurance Verification Specialists- US healthcare

US Healthcare Benefits Verification Specialist

Location: Bangalore
Work Mode: Work From Office (5 Days)
Shift: Rotational Night Shift (5:30 PM – 6:50 AM IST)
Experience: 1–5 Years

Job Summary

We are seeking experienced US Healthcare Benefits Verification Specialists to join our team. The ideal candidate will have hands-on experience in insurance eligibility and benefits verification, strong knowledge of US healthcare payers, and experience interacting with insurance companies to verify patient coverage and benefits.

Key Responsibilities

• Verify patient insurance eligibility and benefits through payer portals and outbound calls.

• Review and validate coverage details, deductibles, co-pay, co-insurance, out-of-pocket maximums, and network status.

• Determine prior authorization requirements for procedures, medications, and treatments.

• Verify CPT, HCPCS, and J-Code-specific benefits and coverage criteria.

• Communicate with insurance representatives to obtain accurate benefit information.

• Document verification details accurately in CRM, EMR, EHR, or RCM systems.

• Ensure all benefit information is updated and maintained as per process guidelines.

• Meet quality and productivity targets while maintaining accuracy.

Required Skills & Experience

• Minimum 6 months of hands-on experience in US Healthcare Insurance Eligibility and Benefits Verification.

• Strong understanding of Commercial, Medicare, Medicare Advantage, Medicaid, Managed Medicaid, HMO, PPO, VA, and DoD/TRICARE plans.

• Experience verifying deductibles, co-pay, co-insurance, prior authorization requirements, and network status.

• Hands-on experience with payer portals such as Availity, NaviNet, Aetna, UHC, Cigna, BCBS, or similar.

• Experience handling outbound calls with US insurance providers.

• Excellent verbal and written communication skills.

• Strong documentation and data management skills.

Preferred Experience

• Specialty Pharmacy

• Oncology

• Infusion Therapy

• Behavioral Health

Important Note

• Candidates from Benefits Verification / Eligibility Verification / Insurance Verification backgrounds are preferred.

• Profiles from Accounts Receivable (AR), Payment Posting, Collections, or Denial Management will not be considered.

• It is a Full Time Customer Support / TeleCaller job for candidates with 6 months - 6 years of experience.