Eligibility verification Specialist

Eligibility Verification Specialist – U.S. Healthcare
Experience: 6 months–1 year
Industry: U.S. Healthcare / Medical Billing / Revenue Cycle Management
Employment Type: Full-Time
Job Summary
We are looking for an Eligibility Verification Specialist with 6 months–1 year of experience in U.S. healthcare insurance verification. The candidate will be responsible for verifying patient insurance eligibility and benefits, accurately documenting coverage details, and identifying authorization, referral, and coverage requirements.
Key Responsibilities
- Verify patient insurance eligibility and benefits through payer portals and/or phone.
- Confirm active/inactive coverage and effective dates.
- Verify deductible, copay, coinsurance, and out-of-pocket maximums.
- Check in-network and out-of-network benefits.
- Identify authorization, referral, and benefit limitations.
- Work with major U.S. insurance payers and portals such as Availity, when applicable.
- Accurately document verification results in the appropriate system or tracker.
- Identify discrepancies in patient and insurance information and follow up as needed.
- Maintain accuracy and meet daily productivity and quality requirements.
- Follow HIPAA and company policies while handling patient information.
- Communicate professionally with insurance representatives when clarification is required.
Required Skills & Qualifications
- 6 months–1 year of experience in U.S. healthcare Eligibility Verification.
- Basic understanding of U.S. health insurance terminology.
- Knowledge of deductible, copay, coinsurance, OOP maximum, HMO, PPO, and network benefits.
- Experience working with insurance portals is preferred.
- Good written and verbal communication skills.
- Strong attention to detail and documentation skills.
- Ability to work independently and meet productivity targets.
- Basic knowledge of medical billing/RCM is preferred.
Preferred Candidate
A candidate who has hands-on experience verifying U.S. healthcare insurance eligibility and benefits and can accurately interpret and document payer responses.
Shift
U.S. Shift / Night Shift
Location
[Work From Home / Office – specify location]
Compensation
[Add salary range]
Interview Process
- HR/Initial Screening
- Eligibility Verification Process Round
- Operations/Final Round

Work arrangement
Yes