Benefit Verification Specialist

1 week ago

Bengaluru, Karnataka, India Talent Giants Consultancy Services Full time

About Company
100ms builds AI agents that automate patient access workflows in U.S. healthcare—beginning with benefits verification, prior authorization, and referral intake for specialty pharmacy. Our platform combines clinical and payer expertise with LLM-based automation and reliable operational infrastructure to reduce administrative delays and help patients start treatment sooner. Join a focused team applying AI to meaningful healthcare problems.

Position: Benefits Verification Specialist (Associate & Team Lead)

We are hiring for the role of
Benefits Verification Specialist
. To provide clarity, this opening includes two levels:

  • Associate Benefits Verification Specialist: 1–4 years of experience in U.S. health insurance eligibility and benefits verification.
  • Team Lead, Benefits Verification: 4–12 years of experience, with demonstrated experience leading or mentoring small teams, driving process improvements, and owning operational SLAs.

Both levels are full-time, in-office roles based in Bangalore, with partial overlap with U.S. 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

  • 1+ years of experience in US healthcare insurance verification
  • Familiarity with payer portals (e.g., Availity, Navinet, Aetna, UHC)
  • Understanding of insurance types (commercial, Medicare, Medicaid, HMO/PPO, etc.)
  • Working knowledge of CPT codes, HCPCS, and payer-specific benefits rules
  • Strong attention to detail and ability to document accurately
  • Proficient in written and spoken English

Good To Have

  • Experience in specialty pharmacy, oncology, infusion therapy, or behavioural health
  • Background working with RCM platforms, EMRs, or AI-based automation tools

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

Skills: health insurance,insurance verification,benefit verification specialist,us healthcare

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