Insurance Verification & Benefits Data Specialist

• Run eligibility and benefits checks in US payer portals for scheduled patients
• Record plan, network status, deductible, out-of-pocket amounts, copay, coinsurance, and prior-authorization requirements in structured forms
• Capture portal PDFs or screenshots as evidence for every verification
• Mark incomplete or contradictory portal data as unknown instead of guessing
• Call payers to verify benefits when portal information is missing or unclear
• Confirm whether procedures identified by CPT code require prior authorization
• Submit prior-authorization requests and follow up until approval before the date of service
• Log representative names, call reference numbers, and outcomes for every payer call
• Follow client call scripts and record calls as directed
• Calculate estimated patient responsibility using the client's written formula and document the steps
• Audit automated output against portal or call results and flag mismatches with specific reasons
• Provide engineering with reproducible feedback and report patterns across cases
• Document payer portal and phone quirks as short how-to notes
• Build and maintain curated checked cases across payers and plan types for regression testing
• Re-check older cases when payer rules change
• Produce approximately 30 new verifications per day or 100–200 QA checks per day depending on task mix
• Report directly to a founder on a small operations and data team

• 2–5 years of hands-on US insurance eligibility and benefits verification and prior authorization experience in an ASC, hospital, or RCM/BPO setting, at volume of 30+ verifications per day
• Daily use of US payer portals such as Availity, UnitedHealthcare, Waystar, or NaviNet
• Outbound payer phone calls for benefits verification and prior authorization follow-up, with call reference numbers logged
• Ability to explain deductible, coinsurance, copay, and out-of-pocket maximum and calculate patient-responsibility estimates
• HIPAA training and PHI handling experience
• English at C1+ CEFR written and B2+ CEFR spoken
• Availability for synchronous work from 10:00 AM to 5:00/6:00 PM Pacific Time
• Verification experience in surgical specialties such as GI, ophthalmology, orthopedics, pain management, or ENT is nice to have
• Medicare Advantage and secondary-coverage case experience is nice to have
• Experience auditing or QA-ing automated or AI-generated output is nice to have
• SQL, data-labeling, or advanced spreadsheet experience is nice to have
• Experience working with minimal supervision, writing SOPs, or training others is nice to have

• Competitive salary based on experience and skills
• Fully remote work from anywhere in the Philippines
• Team incentives and recognition for maintaining 100% CRM hygiene and on-time reporting
• Generous PTO in accordance with company policy
• HMO coverage after 3 months for full-time employees in the Philippines
• Direct mentorship from international industry experts
• Ongoing learning and development resources
• Global networking opportunities