Benefits Verification Specialist (PS)

CareMetx, LLC; United States; Remote; USD 25,000 - 39,000; Full time

Job summary

CareMetx is seeking a Benefits Verification Specialist to verify patient benefits with insurance payers and document coverage for client programs. You will confirm eligibility, cost share, and access options while requesting any missing information.

This role requires at least two years of related experience, strong data entry skills, and proficiency with Fusion and Salesforce. You will collaborate with teams to expedite access and ensure accurate, timely documentation.

Qualifications

• Minimum 2 years related experience in customer service, medical billing or benefits verification.
• Bachelor’s degree preferred; equivalent combination of education and experience considered.
• Must have Fusion and Salesforce experience.

Responsibilities

• Review all patient insurance information needed to complete the benefit verification process.
• Triages cases with missing information to appropriate program associate.
• Verifies patient specific benefits and documents specifics for various payer plans including patient coverage, cost share, and access/provider options.
• Identifies any restrictions and details on how to expedite patient access.
• Could include documenting and initiating prior authorization process, claims appeals, etc.
• Completes quality review of work as part of finalizing product.
• Reports any reimbursement trends/delays to management.
• Performs related duties and special projects as assigned.
• Applies company policies and procedures to resolve a variety of issues.

Skills

Customer service experience

Attention to detail

Analytical skills

Written and verbal communication

Problem solving

Interpersonal skills

Education

Bachelor's degree preferred

Equivalent education and experience considered

Tools

Fusion

Salesforce

Job description

Description

From intake to outcomes, CareMetx is dedicated to delivering industry-leading patient access solutions and support services that help patients quickly start and stay on specialty therapy treatments. We provide scalable, efficient digital hub services for pharmaceutical companies and healthcare providers, streamlining workflows with seamless integration for patient enrollment, consent, and prior authorization. Our best-in-class patient support services enhance every step of care, connecting patients, providers, and brands to drive better outcomes and accelerate time-to-therapy.

From intake to outcomes, CareMetx is dedicated to delivering industry-leading patient access solutions and support services that help patients quickly start and stay on specialty therapy treatments. We provide scalable, efficient digital hub services for pharmaceutical companies and healthcare providers, streamlining workflows with seamless integration for patient enrollment, consent, and prior authorization. Our best-in-class patient support services enhance every step of care, connecting patients, providers, and brands to drive better outcomes and accelerate time-to-therapy.

Job Title:

Benefits Verification Specialist

POSITION SUMMARY:

The Benefits Verification Specialist will contact insurance companies to verify patient specific benefits for client programs. The Benefits Verification Specialist will ask appropriate questions regarding patient's benefits and complete data entry and/or appropriate forms to document patient's benefits coverage.

PRIMARY DUTIES AND RESPONSIBILITIES:

• Reviews all patient insurance information needed to complete the benefit verification process.
• Triages cases with missing information to appropriate program associate.
• Verifies patient specific benefits and precisely documents specifics for various payer plans including patient coverage, cost share, and access/provider options.
• Identifies any restrictions and details on how to expedite patient access.
• Could include documenting and initiating prior authorization process, claims appeals, etc.
• Completes quality review of work as part of finalizing product.
• Reports any reimbursement trends/delays to management.
• Performs related duties and special projects as assigned.
• Applies company policies and procedures to resolve a variety of issues.

Experience and Educational Requirements

• High school diploma or GED required.
• Requires minimum of two (2) years directly related and progressively responsible. experience in customer service, medical billing and coding, benefits verification, healthcare, business administration or similar vocations.
• A bachelor’s degree is preferred.
• An equivalent combination of education and experience will be considered.
• MUST HAVE FUSION/ SALESFORCE EXPERIENCE

Minimum Skills, Knowledge and Ability Requirements

• Advanced customer service experience.
• Proficient Windows-based experience including fundamentals of data entry/typing.
• Proficient with Microsoft Outlook, Word, and Excel.
• Strong interpersonal skills and professionalism.
• Independent problem solver and ability to make , good decisions.
• Robust analytical skills.
• Strong attention to detail.
• Effective written and verbal communication.
• Familiarity with verification of insurance benefits preferred.
• Attention to detail, flexibility, and the ability to adapt to changing work situations. Quality review of work as part of finalizing product.
• Reports any reimbursement trends/delays to management.
• Performs related duties and special projects as assigned.
• Applies company policies and procedures to resolve a variety of issues.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to sit.
• The employee must occasionally lift and/or move up to 10 pounds.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

Schedule

• Must be flexible on schedule and hours.
• Some Travel may be required.

CareMetx

At CareMetx we work hard, we believe in what we do, and we want to be a company that does right by our employees. Our niche industry is an integral player in getting specialty products and devices to the patients who need them by managing reimbursements for those products, identifying alternative funding when insurers do not pay, and providing clinical services.

Artificial Intelligence in Our Recruiting and Employment Process

CareMetx uses artificial intelligence and automated decision-making technology to support parts of our recruiting, hiring, and employment process, including screening applications, scheduling interviews, and evaluating candidate qualifications. These tools support, not replace, human judgment. A qualified member of our team reviews and makes all final hiring and employment decisions.

CareMetx does not develop or use AI tools with the intent to discriminate against applicants or employees on the basis of race, color, religion, sex, age, sexual orientation, national origin, disability, veteran status, or any other protected characteristic.

CareMetx is an equal employment opportunity employer. All qualified applicants will receive consideration for employment and will not be discriminated against based on race, color, sex, sexual orientation, gender identity, religion, disability, age, genetic information, veteran status, ancestry, or national or ethnic origin.

CareMetx uses artificial intelligence and automated decision-making technology to support parts of our recruiting, hiring, and employment process, including screening applications, scheduling interviews, and evaluating candidate qualifications. These tools support, not replace, human judgment. A qualified member of our team reviews and makes all final hiring and employment decisions.

CareMetx does not develop or use AI tools with the intent to discriminate against applicants or employees on the basis of race, color, religion, sex, age, sexual orientation, national origin, disability, veteran status, or any other protected characteristic.