ABA Insurance Verifications, QA Specialist

🔥 5 hours ago

🇿🇦 South Africa – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔧 QA Engineer (Quality Assurance)

👻 Ghost score 10%

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iSTA Solutions

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

📦 Logistics

📣 Marketing

Healthcare • Logistics • Marketing

iSTA Solutions is your remote healthcare operations partner specializing in off-site staffing solutions. With over 20 years of experience, we focus on enhancing operational efficiency for businesses, particularly in the healthcare sector, by providing customized remote teams that take on tasks ranging from customer service to data entry. Our goal is to support organizations in scaling their operations seamlessly while achieving significant cost savings and improved productivity.

📋 Description

• Pick up benefit checks from the Monday.com board for new enquiries and existing clients who change insurance • Call US insurers to verify out-of-network benefits across ABA, occupational therapy, speech and language, and related services • Verify coverage or exclusions, visit limits, deductibles, co-insurance and maximum out-of-pocket amounts • Record insurance benefits accurately on the board • Send patient responsibility contracts to parents after payment plans are agreed and follow up until signed and returned • Load real or placeholder authorisations into CentralReach so therapists can bill • Extend or renew authorisations before January and re-verify every client’s benefits during the first two weeks of January • Review flagged session notes in CentralReach and NoteGuard AI • Check that amendment notes are signed and clear labels so sessions can move to payroll • Resolve rule flags internally where possible and escalate issues to therapists when needed • Over time, support authorisation utilisation checks, timesheet authorisation issues and follow-up on unconverted timesheets • Support a small in-office team in a fully remote, back-office role, with potential to grow into staff-facing work

🎯 Requirements

• ABA industry experience with a solid understanding of terminology including timesheets, goals, session notes, QA and authorisations; ABA recruiting, onboarding or admin experience is sufficient • Comfortable speaking with US insurers via telecom • Proficiency in Microsoft 365, including Outlook and Excel • Excellent written and spoken English • Strong attention to detail and accuracy • Initiative to question anything that looks off rather than simply following the workflow • Habit of communicating fully and proactively, giving real updates rather than one-word answers • Confident, personable manner and an easy way of working with others • CentralReach experience beneficial • Monday.com experience beneficial • US health insurance or benefits verification experience, ideally across ABA, OT and speech, beneficial • Experience working with US or international clients beneficial • Creative thinker who takes initiative, discusses ideas, asks questions and communicates effectively • Friendly, pleasant and forthcoming personality • Fixed fibre line with minimum 25 Mbps upload and download, supporting a wired Ethernet connection • Reliable power backup solution for load shedding and power outages • Must be based in South Africa • Must work Monday to Friday, 16:00–01:00 SAST, subject to US daylight saving changes • Must work on South African and U.S. public holidays

🏖️ Benefits

• Compensation for South African public holidays in accordance with the BCEA • Fully remote working arrangement • Monday to Friday working hours

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