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Pearl TalentRemote Insurance Verification & Benefits Data Specialist
Pearl Talent is assisting an early-stage healthcare artificial intelligence enterprise that creates automation solutions for insurance verification and prior authorizations for American hospital systems and surgery…
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About This Role
Pearl Talent is assisting an early-stage healthcare artificial intelligence enterprise that creates automation solutions for insurance verification and prior authorizations for American hospital systems and surgery centers. The company is searching for an Insurance Verification & Benefits Data Specialist to work remotely from anywhere in the Philippines. This position represents the inaugural hire for a compact data and operations group, operating in a lean structure and reporting directly to one…
Job Description
Pearl Talent is assisting an early-stage healthcare artificial intelligence enterprise that creates automation solutions for insurance verification and prior authorizations for American hospital systems and surgery centers. The company is searching for an Insurance Verification & Benefits Data Specialist to work remotely from anywhere in the Philippines. This position represents the inaugural hire for a compact data and operations group, operating in a lean structure and reporting directly to one of the founders.
The person in this role will conduct insurance eligibility and benefits checks through American payer portals, place telephone calls to payers when information is unclear, manage prior authorization requests through to approval, and compute estimated patient financial responsibility. Additional duties include reviewing automated system results against portal and telephone findings, recording payer-specific behaviors, and preserving a structured collection of verified cases for regression testing. The targeted output is roughly thirty new verifications daily or one hundred to two hundred quality assurance checks daily. Successful execution requires recording every data field uniformly with attached evidence, highlighting unknowns instead of making assumptions, and detailing discrepancies with specific and reproducible explanations.
The ideal candidate possesses practical background in American insurance eligibility verification and prior authorizations within ambulatory surgery centers, hospitals, or revenue cycle management environments. Applicants must be comfortable handling protected health information, meeting daily volume targets, and maintaining availability during specified Pacific Time hours.
Responsibilities
- Perform eligibility and benefits checks within American payer portals for scheduled patients
- Record specific details such as plan type, network standing, deductibles, out-of-pocket maximums, copays, coinsurance, and prior authorization rules into a structured form
- Capture portal PDF documents or screenshots as evidence for every verification completed
- Contact payers via telephone when portal data is missing or unclear to verify benefits and determine prior authorization needs for specific CPT codes
- Submit prior authorization requests and track them until approval is achieved prior to the date of service
- Log representative names, call reference numbers, and outcomes for every telephone interaction
- Compute estimated patient responsibility utilizing a provided written formula and document the calculation steps
- Review automated outputs against portal and call findings, flagging mismatches with specific explanations
- Document portal and phone quirks as short guides and maintain a curated set of checked cases for regression testing
Requirements
- Two to five years of hands-on experience with United States insurance eligibility and benefits verification and prior authorizations in an ambulatory surgery center, hospital, or revenue cycle management setting
- Demonstrated ability to handle a volume of thirty or more verifications per day
- Frequent utilization of United States payer portals such as Availity, UnitedHealthcare, Waystar, or NaviNet
- Experience making outbound payer telephone calls for verification and prior authorization follow-up while logging reference numbers
- Proficiency in explaining deductibles, coinsurance, copays, and out-of-pocket maximums to calculate patient responsibility estimates
- Prior HIPAA training and experience handling protected health information
- Written English proficiency at C1+ CEFR level and spoken proficiency at B2+ CEFR level
- Availability for synchronous work from 10:00 AM to 5:00 or 6:00 PM Pacific Time
Qualifications
- Verification background in surgical specialties including gastroenterology, ophthalmology, orthopedics, pain management, or ear, nose, and throat
- Experience with Medicare Advantage and secondary coverage cases
- Background in auditing or performing quality assurance on automated or artificial intelligence-generated outputs
- Familiarity with SQL, data labeling, or advanced spreadsheets
- Experience operating with minimal supervision, functioning as a sole verifier, drafting standard operating procedures, or training others
Core Skills
Benefits
- Competitive salary based on experience and skills
- Fully remote work arrangement allowing work from anywhere
- Team incentives recognizing 100 percent CRM hygiene and on-time reporting
- Generous paid time off in accordance with company policy
- HMO health coverage for Philippines-based talent after three months for full-time employees
- Direct mentorship from international industry experts
- Ongoing access to professional growth and learning resources
- Opportunities for global networking
Frequently Asked Questions
Answers are based only on the employer’s listing; where it doesn’t say, neither do we.
Where is this job located?
The position is fully remote, allowing the employee to work from anywhere in the Philippines while maintaining synchronous availability during Pacific Time hours.
What are the working hours for this role?
Synchronous availability is required from 10:00 AM to 5:00 or 6:00 PM Pacific Time.
What is the salary for this position?
The salary is competitive and determined based on the applicant's experience and skills, though a specific figure is not stated in the job posting.
What experience is required to apply?
Candidates must have two to five years of hands-on experience with United States insurance eligibility and benefits verification and prior authorization at volume in an ambulatory surgery center, hospital, or revenue cycle management setting.
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