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

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.