Insurance Verification & Benefits Data Specialist

PearlHealthcare AI

Work From Anywhere in the Philippines, PST; synchronous availability required 10:00 AM–5:00/6:00 PM Pacific TimeFull-TimeSenior

Salary not disclosed

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Job Details

Languages: English at C1+ CEFR (written) and B2+ CEFR (spoken)
Experience: 2–5 years of hands-on US insurance eligibility and benefits verification and prior authorization
Required Skills: SQLHIPAA

Have 2–5 years of hands-on US insurance eligibility and benefits verification and prior-authorization experience in an ASC, hospital, or RCM/BPO setting.
Have experience handling at least 30 verifications per day.
Use US payer portals daily, such as Availity, UnitedHealthcare, Waystar, or NaviNet.
Make outbound payer calls for benefits verification and prior-authorization follow-up, and log call reference numbers.
Be able to explain deductible, coinsurance, copay, and out-of-pocket maximum and calculate estimated patient responsibility.
Have HIPAA training and PHI handling experience.
Have English proficiency at C1+ CEFR written and B2+ CEFR spoken.
Be available for synchronous work from 10:00 AM to 5:00/6:00 PM Pacific Time.
Surgical-specialty verification, Medicare Advantage and secondary-coverage cases, auditing automated or AI-generated output, SQL, data-labeling, or advanced spreadsheet experience are nice to have.

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 a structured form.
Capture portal PDFs or screenshots as evidence for each verification.
Call payers when portal information is missing or unclear and confirm prior-authorization requirements by CPT code.
Submit prior-authorization requests and follow up until approval before the date of service.
Log the representative's name, call reference number, and outcome for each call.
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 a reason.
Document payer portal and phone quirks as short how-to notes.
Maintain checked cases for regression testing and re-check older cases when payer rules change.

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