Remote Insurance Verification & Benefits Data Specialist
Pearl · Remote
Work From Anywhere in the Philippines
Work Schedule: PST │ 10:00 AM – 5:00/6:00 PM, synchronous availability required
About Pearl Talent
Pearl works with the top 1% of candidates from around the world and connects them with the best startups in the US and EU. Our clients have raised over $5B in aggregate and are backed by companies like OpenAI, a16z, and Founders Fund.
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About the Client
An early-stage healthcare AI company building automation for insurance verification and prior authorization for US surgery centers and hospital systems is looking for an Insurance Verification Specialist to produce structured, checked benefits data and audit the accuracy of its automated output.
Today the company relies on its customers’ verifiers, whose free-text notes are fast but inconsistent and cannot be analyzed at scale. This is the first hire on a small operations and data team, reporting directly to a founder in a lean environment with a 1–2 week onboarding.
About the Role
The Insurance Verification Specialist runs eligibility and benefits checks in US payer portals, calls payers when portal data is missing or unclear, follows prior authorization requests through to approval, and calculates estimated patient responsibility from a written formula. The role also audits the automation’s output against portal and call results, documents payer quirks, and maintains a curated set of checked cases for regression testing. Expected output is about 30 new verifications per day, or 100–200 QA checks per day depending on task mix. Success means every field recorded the same way with evidence attached, unknowns flagged instead of guessed, and mismatches reported with specific, reproducible reasons.
Core Responsibilities
Eligibility & Benefits Verification
- Run eligibility and benefits checks in US payer portals (UnitedHealthcare, Availity, Waystar, BCBS, Aetna, Cigna, Medicare / Medicare Advantage) for scheduled patients.
- Record each field in a structured form: plan, network status, deductible and out-of-pocket (individual and family, total and met), copay, coinsurance, and prior-auth requirement.
- Capture the portal PDF or screenshot as evidence for every verification.
- Mark incomplete or contradictory portal data as unknown instead of guessing.
Payer Calls & Prior Authorization
- Call payers to verify benefits when the portal is missing or unclear, and confirm whether a procedure (by CPT code) needs prior authorization.
- Submit prior authorization requests and follow up until approved before the date of service.
- Log the rep name, call reference number, and outcome in the structured form for every call.
- Follow client call scripts and record calls as directed.
Patient Responsibility & Data Quality
- Calculate estimated patient responsibility using the client’s written formula (allowable, deductible, copay, coinsurance, out-of-pocket cap) and document the steps.
- Audit automated output against portal or call results and flag each mismatch with a one-line reason: automation error, payer data issue, or ambiguous.
- Give the engineering team specific, reproducible feedback and report patterns across cases.
Documentation & Quality Standards
- Document payer portal and phone quirks (where a figure lives, which payers need a call, workarounds) as short how-to notes.
- Build and maintain a curated set of checked cases across payers and plan types for regression testing.
- Re-check older cases when payer rules change.
Requirements
Must-Have
- 2–5 years of hands-on US insurance eligibility and benefits verification and prior authorization in an ASC, hospital, or RCM/BPO setting, at volume (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 to calculate a patient-responsibility estimate from them
- HIPAA training and PHI handling experience
- English at C1+ CEFR (written) and B2+ CEFR (spoken)
- Availability for synchronous work 10:00 AM – 5:00/6:00 PM Pacific Time
Nice-to-Have
- Verification experience in surgical specialties: GI, ophthalmology, orthopedics, pain management, or ENT
- Medicare Advantage and secondary-coverage case experience
- Experience auditing or QA-ing automated or AI-generated output
- SQL, data-labeling, or advanced spreadsheet experience
- Experience working with minimal supervision, such as sole verifier, writing SOPs, or training others
Benefits
- Competitive Salary: Based on experience and skills
- Remote Work: Fully remote—work from anywhere
- Team Incentives: Recognition for maintaining 100% CRM hygiene and on-time reporting
- Generous PTO: In accordance with company policy
- Health Coverage for PH-based talents: HMO coverage after 3 months for full-time employees
- Direct Mentorship: Guidance from international industry experts
- Learning & Development: Ongoing access to resources for professional growth
- Global Networking: Connect with professionals worldwide
Our Recruitment Process
- Application
- Screening
- Skills Assessment
- Topgrading Interview
- Client Interview
- Job Offer
- Client Onboarding
Ready to Join Us?
If you’re empathetic, organized, and passionate about improving patient experiences through operational excellence, this role is for you. Apply now to help make specialized healthcare more accessible to patients across the U.S.