Job Summary
We are hiring a Benefit Verification Specialist with experience in US healthcare insurance eligibility and benefits verification. The role involves verifying insurance coverage details for patients receiving specialty healthcare services in the United States.
This is a full-time, in-office position based in Bengaluru with partial overlap with US working hours.
Key Responsibilities
- Perform insurance eligibility and benefits verification for commercial and government payers, including Medicare, Medicare Advantage, Medicaid, Managed Medicaid, VA, and DoD.
- Verify coverage details such as deductibles, co-pay/coinsurance, network status, referral requirements, prior authorization requirements, and J-code/CPT/HCPCS-specific benefits.
- Contact payer representatives via phone and payer portals to obtain accurate benefit information.
- Document benefit verification details accurately in internal systems (CRM, RCM, or EMR platforms).
- Follow up with payers when clarification or correction is required.
- Collaborate with internal operations and technology teams to resolve discrepancies and improve workflow processes.
- Ensure verifications are completed within defined service-level timelines and maintain high accuracy standards.
Required Qualifications
- Minimum 6 months of hands-on experience in US healthcare insurance eligibility and benefits verification.
- Strong understanding of insurance types including Commercial, Medicare, Medicare Advantage, Medicaid, Managed Medicaid, HMO/PPO, VA, and DoD plans.
- Experience verifying deductibles, co-pay/coinsurance, prior authorization requirements, network participation, and J-code/CPT/HCPCS-related benefits.
- Experience documenting benefit details accurately in CRM, RCM, or EMR systems.
- Prior experience handling outbound or inbound calls with US insurance payers.
- Good verbal and written communication skills.
Additional Requirements
- Experience must be in insurance eligibility and benefits verification.
- Profiles focused only on accounts receivable (AR) or post-insurance follow-up will not be considered.
Preferred Qualifications
- Experience in specialty pharmacy, oncology, infusion therapy, or behavioral health benefit verification.
- Experience working in a structured SLA-driven environment.
Work Environment
- Full-time, in-office role
- Opportunity to work cross-functionally with operations and technology teams
- Exposure to US healthcare processes and systems
Job Type: Full-time
Pay: ₹500,000.00 - ₹600,000.00 per year
Benefits:
- Health insurance
- Paid time off
- Provident Fund
Application Question(s):
- 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.)
- Do you have calling experience for healthcare benefits (It should be mentioned in resume)?
- Do you have strong understanding of insurance types — Commercial, Medicare, Medicare Advantage, Medicaid, Managed Medicaid, HMO/PPO, VA, DoD, etc?
- Do you have experience in verifying deductibles, co-pay/coinsurance, prior authorization requirements, network status, and J-code/CPT/HCPCS-specific benefits?
Experience:
- US healthcare insurance: 1 year (Required)
- Benefit/ Insurance Verification: 1 year (Required)
Language:
Work Location: On the road
