BenefitsSupportSpecialist

Position Summary The Benefits Verification Specialist is responsible for conducting outbound calls to insurance carriers to manually verify patient or client insurance benefits. Based on the outcome of each verification call, this individual accurately routes or advances the case through the appropriate workflow pathway. Key Responsibilities - Place outbound calls to insurance carriers and navigate payer phone systems to reach eligibility and benefits representatives - Verify active coverage and obtain detailed benefits information including deductibles, copays, coinsurance, out-of-pocket maximums, prior authorization requirements, and in/out-of-network benefit levels - Accurately document all information obtained during each call, including reference numbers, representative names, and call timestamps - Interpret call outcomes and apply decision criteria to move each case to the correct next step in the workflow (e.g., eligible for services, requires prior auth, inactive/terminated coverage, patient financial responsibility assessment, denial routing) - Identify discrepancies between payer-reported benefits and information on file and escalate appropriately - Meet daily productivity and quality standards for call volume and documentation accuracy - Maintain working knowledge of common insurance terminology, plan types (HMO, PPO, EPO, HDHP), and payer-specific requirements Required Qualifications - 1+ years of experience in medical billing, insurance verification, or a related healthcare administrative role - Minimum 1 year of customer support experience (call center experience is preferred). - Familiarity with insurance benefits terminology and payer communication processes, - Strong attention to detail and ability to accurately transcribe information in real time with low/no errors - Ability to independently assess call outcomes and apply routing logic without constant supervision - Comfortable with high call volumes and navigating automated payer phone systems - P