Remote Insurance Verification & Benefits Data Specialist

Pearl Talent; Manila; Remote; PHP 2,520,000 - 4,411,000; Full time

Job summary

Pearl Talent is seeking an Insurance Verification Specialist to support an early-stage healthcare AI client building automated insurance verification for US surgery centers and hospital systems. You will run eligibility checks, handle prior authorizations, and audit automated outputs, ensuring accuracy and traceability.

This is a senior-level verifier role with 2–5 years of US insurance experience, requiring daily use of payer portals and synchronous work aligned to US Pacific Time.

Qualifications

• 2–5 years of hands-on US insurance eligibility and benefits verification 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

Responsibilities

• Run eligibility and benefits checks in US payer portals for scheduled patients.
• Call payers to verify benefits when data is missing or unclear and confirm prior authorization needs.
• Submit prior authorization requests and follow up until approved before the date of service.
• Log the rep name, call reference number, and outcome for every call.
• Follow client call scripts and record calls as directed.
• Calculate estimated patient responsibility using the client's formula and document steps.
• Audit automated output versus portal results and flag mismatches with clear reasons.
• Provide reproducible feedback to engineering and report patterns across cases.
• Document payer portal quirks and update SOPs as needed.
• Build and maintain a set of checked cases for regression testing.

Skills

US insurance verification

Prior authorization

Payer portals

HIPAA / PHI handling

English proficiency

Synchronous availability

Tools

Availity

UnitedHealthcare

Waystar

NaviNet

Cigna

BCBS

Job description

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.

Hear why we exist, what we believe in, and who we're building for:

Watch here: https://www.loom.com/share/863b8e426e6d48309aa8f4ea4c1c94cd

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