Job Duties and Responsibilities:

Patient Outreach & Support

Contact past patients to obtain updated or missing information needed for claim processing, such as insurance information etc.
Follow up with patients regarding coordination of benefits (COB) when dual insurance coverage exists.
Educate patients on required actions with their insurance providers and ensure timely follow-up.
Document all activities accurately on client platforms
Handle payer communications through portals and outbound calls
Flag discrepancies or missing information for client review

Provider Communication

Reach out to referring physician offices to request or provide needed information such as alternative diagnosis codes accepted by patient payers etc.
Coordinate with provider offices to ensure claims meet payer requirements
Handle payer communications through portals and outbound calls
Flag discrepancies or missing information for client review

Eligibility & Claims Follow-Up

Perform and support insurance verification, benefits investigation, and eligibility checks
Perform basic eligibility verification follow-ups with patients to resolve outstanding issues.
Track and manage claim-related communications to ensure resolution and submission readiness.
Validate patient eligibility, coverage, and payer requirements in the tools and system (e.g payer portals).
Review complex cases, escalations, and payer-related issues, then elevate to the client as needed
Ensure accurate documentation in client systems including EMR and DME platforms
Ensure alignment with payer guidelines and billing requirements as defined by the client

Systems & Documentation

Utilize EMR and CRM systems to review patient records and update insurance information as needed.
Use Microsoft Teams and internal dashboards/portals to manage workflows and communication.
Maintain accurate, detailed documentation of all interactions and updates.

Required Skills & Qualifications

Experience in healthcare customer service, medical billing, or claims support is preferred.
Experience in Members and Provider calls is preferred.
Experience basic eligibility checks and benefit investigation is an advantage.
Experience and knowledge on coordination of benefits (COB)
Strong communication and interpersonal skills.
High attention to detail and ability to manage multiple follow-ups.
Familiarity with EMR systems, CRM tools, and Microsoft Teams
Problem-solving mindset with a focus on timely resolution
Customer-focused communication.
Organization and time management skills.
Analytical thinking for claims and eligibility issues.
Collaboration across patients, providers, and internal teams

Job Required Qualification:

Minimum 3-year solid experience with US Healthcare Insurance
At least 1 year work experience in a customer service call center (Voice and Back office)
Strong knowledge on doing Members and provider outreach/calling.
Familiarity with EMR, DME systems, payer portals, and database entry
Strong understanding of HIPAA compliance and medical terminology
Ability to manage high volume workloads and meet performance targets
Proficiency in MS Word, Excel, and Outlook
Experience and Exposure with medical Insurance/Benefits investigation and Authorizations.
High attention to detail and documentation accuracy
Excellent Customer service skills, including phone and interpersonal skills.
Typing speed of at least 35 WPM with high accuracy
Database data entry experience preferred.
Strong English proficiency, both written and verbal
Strong attendance, reliability, and accountability
Ability to work effectively with diverse teams and clients
High comfort level working with culturally diverse team members and clients.
Proficient mathematical skills, including addition, subtraction, multiplication, and division.

Preferred Qualifications:

Knowledge on DME products (e.g Diabetes Supplies)

Member and Provider Support Specialist (TEMPORARY ROLE)

Key skills