Health Insurance Verification / Insurance Verification Specialist

SGS Consulting; Atlanta (GA); On-site; USD 42,000 - 54,000; Full time

Job summary

SGS Consulting is seeking an enrollment support professional in Georgia to assist Medicaid-eligible recipients and families with HIPP and Premium Assistance. You will verify coverage, collect documents, and manage open enrollment cycles while handling high call volumes and complex cases.

The role emphasizes customer service, policy knowledge, and document review, with opportunities to support audits and program reporting.

Qualifications

• Substantial customer service experience in a fast-paced setting.
• Basic knowledge of health insurance terminology and plans.
• Experience verifying Medicaid eligibility or related programs is a plus.

Responsibilities

• Provide enrollment guidance to Medicaid-eligible recipients and families by phone or correspondence.
• Verify and document health coverage for Medicaid recipients and dependents (employer plans, COBRA, etc.).
• Identify members who may qualify for HIPP / Premium Assistance.
• Obtain and verify eligibility documents such as insurance policies and employment verification.
• Maintain active case files during open enrollment, premium review, and payments.
• Process and follow up on premium payments and reimbursements, tracking discrepancies.
• Maintain records with status changes, renewals, terminations, or escalations.
• Prepare periodic reporting on case metrics and enrollment trends.
• Handle high volumes of inquiries about eligibility, coverage, and program rules.
• Conduct advanced document review or escalations on complex cases as needed.
• Prioritize events, manage deadlines, and escalate issues to supervisors when appropriate.
• Demonstrate strong customer service, multi-tasking, and Excel proficiency.

Skills

Insurance Verification

Health Insurance

Medicaid Verification

Customer Service

HIPAA

Education

Bachelor's degree preferred

Tools

Excel

Job description

Job Responsibilities

• Provide enrollment assistance and guidance to Medicaid-eligible recipients and their families regarding the HIPP / Premium Assistance program via phone or correspondence.
• Verify, document, and investigate existing health coverage for Medicaid recipients and their dependents (employer plans, COBRA, etc.).
• Assist in identifying members who may qualify for HIPP / Premium Assistance.
• Obtain and verify documents required for eligibility: insurance policies, employment verification, premium invoices, etc.
• Maintain active case files during open enrollment cycles, premium review, and payment processing.
• Process, review, and follow up on premium payments / reimbursements, ensuring timely and accurate payments, and tracking any discrepancies.
• Perform ongoing case maintenance and audits, updating records for status changes, renewals, terminations, or escalations.
• Complete periodic reporting (e.g. case metrics, enrollment trends, audit reports) as required by state or internal stakeholders.
• Respond to high volumes of inbound and outbound calls and inquiries about eligibility, coverage, program rules, and status.
• Conduct advanced document review, legal research or case escalation as needed, particularly on more complex cases.
• Prioritize case events, manage deadlines, elevate issues to supervisors or subject matter experts when appropriate.
• Substantial customer service experience, ability to multi-task in a fast-paced environment, basic knowledge of health insurance and health insurance terminology, Excel Microsoft knowledge.

Skills

• Insurance Verification
• Health Insurance
• Medicaid Verification
• Customer Service
• HIPAA

Education/Experience

Some colleges are desirable. A bachelor’s would be nice but not required.