Benefit Verification Specialist (Health Insurance, USA)

About the Role

We are hiring a Benefits Verification Specialist to join our growing healthcare operations team at 100ms.

This role sits at the intersection of US healthcare operations and technology, where youll play a critical part in verifying patient insurance benefits and enabling seamless access to care. You will work closely with internal teams and contribute to improving operational workflows in a fast-paced environment.

Key Responsibilities

• Perform insurance eligibility & benefits verification for US patients (Commercial, Medicare, Medicaid, etc.)
• Validate key coverage details: deductibles, co-pay, coinsurance, network status, referrals, prior authorization
• Verify CPT / HCPCS / J-code-specific benefits
• Interact with payer representatives via calls and payer portals
• Accurately document and maintain data in CRM / RCM / EMR systems
• Collaborate with internal teams to resolve data gaps and discrepancies
• Ensure high accuracy, productivity, and SLA adherence
• Identify opportunities to improve processes and system efficiency

Ideal Candidate

• 14 years of experience in US Healthcare Insurance Verification / RCM
• Minimum 6 months hands-on experience in eligibility & benefits verification
• Strong understanding of:
• Commercial, Medicare, Medicare Advantage
• Medicaid, Managed Medicaid, HMO/PPO, VA, DoD
• Experience verifying:
• Deductibles, co-pay, coinsurance
• Prior authorization requirements
• Network status and CPT/HCPCS/J-code benefits
• Comfortable with US calling (payer interactions)
• Strong communication, attention to detail, and documentation skills

Preferred

• Experience in specialty pharmacy, oncology, infusion therapy, or behavioral health
• Exposure to complex or high-value benefit verification cases

Location & Work Details

• Bangalore (In-office)
• Full-time role
• Partial overlap with US working hours

Why Join Us

• Work on critical healthcare workflows impacting patients in the US
• Be part of a high-growth, fast-paced startup environment
• High ownership with strong learning and growth opportunities
• Collaborate with cross-functional teams including product & technology