Medical Eligibility Specialists

Virtuale Staffing; Cebu City; On-site; PHP 240,000 - 360,000; Full time

Job summary

Virtuale Staffing in Cebu City, Philippines, seeks an Insurance Verification Specialist to review patient coverage for orthodontic procedures and confirm eligibility via portals or phone.

You will document details in the patient management system, communicate with insurers, flag ineligible coverage, and coordinate with front desk to ensure patients understand their benefits before treatment.

Qualifications

• Minimum 1 year of BPO customer service experience.
• Preference for insurance verification in dental orthodontics.
• Excellent attention to detail and data accuracy.
• Strong communication and interpersonal skills.
• Ability to work in a fast-paced, deadline-driven environment.

Responsibilities

• Review and verify patient insurance eligibility for orthodontic procedures via online portals or by phone.
• Confirm coverage details including plan type, lifetime maximums, deductible, co-pay, coinsurance, and frequency limitations.
• Document all insurance information accurately in the patient management system.
• Communicate with insurance companies to clarify benefit details as needed.
• Flag and escalate issues such as ineligible coverage, policy terminations, or unusual plan exclusions.
• Coordinate with front office or scheduling teams to inform patients of coverage prior to treatment.
• Maintain up-to-date knowledge of providers’ policies and orthodontic codes (e.g., D8080, D8090).
• Meet performance standards for productivity, accuracy, and turnaround time.

Skills

BPO experience

Insurance verification

Attention to detail

Communication skills

Deadline-driven

Job description

Qualifications:

• Must have at least 1 year of BPO experience in customer service.
• Preferably with prior experience in insurance verification, especially in a dental orthodontic setting.
• Excellent attention to detail and data accuracy.
• Strong communication and interpersonal skills.
• Ability to work in a fast-paced, deadline-driven environment.

Key Responsibilities:

• Review and verify patient insurance eligibility for orthodontic procedures via online portals or by phone.

• Confirm coverage details including plan type, orthodontic lifetime maximums, deductible, co-pay, coinsurance, and frequency limitations.

• Document all insurance information accurately in the patient management system.

• Communicate with insurance companies to clarify benefit details as needed.

• Flag and escalate issues such as ineligible coverage, policy terminations, or unusual plan exclusions.

• Coordinate with front office or scheduling teams to ensure patients are informed of their coverage prior to treatment.

• Maintain up-to-date knowledge of insurance providers’ policies and orthodontic codes (e.g., D8080, D8090).

• Meet performance standards for productivity, accuracy, and turnaround time.