Benefit Verification Specialist (Health Insurance, USA) Full Time NEW

We’re hiring a Benefits Verification Specialist with 1–4 years of experience in US health insurance eligibility and benefits verification. You’ll 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.

Ideal Candidate

• Strong Benefit/ Insurance Verification 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) – Strong understanding of insurance types — Commercial, Medicare, Medicare Advantage, Medicaid, Managed Medicaid, HMO/PPO, VA, DoD, etc.
• Mandatory (Experience 3) – Experience in verifying deductibles, co-pay/coinsurance, prior authorization requirements, network status, and J-code/CPT/HCPCS-specific benefits.
• Mandatory (Experience 4) – Ability to accurately document benefit details and maintain data in internal systems (CRM, RCM, or EMR platforms)
• Mandatory (Experience 5) – Ability to accurately document benefit details and maintain data in internal systems (CRM, RCM, or EMR platforms)
• Mandatory (Skills) – Good communication skills (Must have calling experience to US audience for claims)
• Mandatory (Note) – Don’t want post insurance verification profiles (Accounts receivables AR etc)
• Preferred (Experience) – Prior experience in specialty pharmacy, oncology, infusion therapy, or behavioral health benefit verification.

Perks, Benefits and Work Culture

• Be part of a team solving critical problems in healthcare automation
• High-ownership role in a startup culture with mentorship and fast learning
• Work closely with product and engineering teams building cutting-edge AI agents
• Contribute to improving access to care for patients across the U.S.

Skills: insurance,medicare,eligibility,medicaid,health,insurance verification