Insurance Verification & Benefits Data Specialist

Job not on LinkedIn

🔥 0 minutes ago

🇵🇭 Philippines – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔒 Insurance

🚫👨‍🎓 No degree required

👻 Ghost score 25%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Catena

WebsiteLinkedInAll Job Openings

1 - 10 employees

💼 Consulting

🏥 Healthcare

📦 Logistics

Consulting • Healthcare • Logistics

Catena, now known as Pearl Talent, is a company that specializes in helping organizations hire top remote talent from overseas, primarily focusing on candidates from the Philippines and Latin America. They offer a rigorous vetting process to ensure they provide highly capable candidates equipped with modern software skills and fluent English proficiency. Pearl Talent provides two main hiring services: Managed Services, which handles compliance, payroll, and training, and Direct Placement for companies that manage hires internally. They focus on long-term retention and quality in their hiring processes, aiming to build high-performing remote teams for a range of industries including healthcare, real estate, and finance.

📋 Description

• Run eligibility and benefits checks in US payer portals for scheduled patients • Record plan, network status, deductible, out-of-pocket amounts, copay, coinsurance, and prior-authorization requirements in structured forms • Capture portal PDFs or screenshots as evidence for every verification • Mark incomplete or contradictory portal data as unknown instead of guessing • Call payers to verify benefits when portal information is missing or unclear • Confirm whether procedures identified by CPT code require prior authorization • Submit prior-authorization requests and follow up until approval before the date of service • Log representative names, call reference numbers, and outcomes for every payer call • Follow client call scripts and record calls as directed • Calculate estimated patient responsibility using the client's written formula and document the steps • Audit automated output against portal or call results and flag mismatches with specific reasons • Provide engineering with reproducible feedback and report patterns across cases • Document payer portal and phone quirks as short how-to notes • Build and maintain curated checked cases across payers and plan types for regression testing • Re-check older cases when payer rules change • Produce approximately 30 new verifications per day or 100–200 QA checks per day depending on task mix • Report directly to a founder on a small operations and data team

🎯 Requirements

• 2–5 years of hands-on US insurance eligibility and benefits verification and prior authorization experience in an ASC, hospital, or RCM/BPO setting, at volume of 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 calculate patient-responsibility estimates • HIPAA training and PHI handling experience • English at C1+ CEFR written and B2+ CEFR spoken • Availability for synchronous work from 10:00 AM to 5:00/6:00 PM Pacific Time • Verification experience in surgical specialties such as GI, ophthalmology, orthopedics, pain management, or ENT is nice to have • Medicare Advantage and secondary-coverage case experience is nice to have • Experience auditing or QA-ing automated or AI-generated output is nice to have • SQL, data-labeling, or advanced spreadsheet experience is nice to have • Experience working with minimal supervision, writing SOPs, or training others is nice to have

🏖️ Benefits

• Competitive salary based on experience and skills • Fully remote work from anywhere in the Philippines • Team incentives and recognition for maintaining 100% CRM hygiene and on-time reporting • Generous PTO in accordance with company policy • HMO coverage after 3 months for full-time employees in the Philippines • Direct mentorship from international industry experts • Ongoing learning and development resources • Global networking opportunities