Medical Claims Examiner

2 days ago

Karachi, Sindh, Pakistan beBeeInsuranceVerification Full time 2,500,000 - 4,000,000
Job Title: Insurance Verification Professional

We are seeking a highly skilled and detail-oriented Insurance Verification Professional to join our organization. The ideal candidate will possess excellent communication skills, a strong command of insurance portals, and a deep understanding of payer-specific rules.

This is a full-time position requiring the selected candidate to work night shifts aligned with U.S. Central Time (8 PM – 4 AM PKT). The Associate – Insurance Verification will be responsible for obtaining accurate patient insurance benefit information, verifying coverage, identifying authorizations/referrals, and ensuring proper documentation to streamline the revenue cycle.

Key Responsibilities:
  • Verify patient insurance eligibility and benefits for psychiatric services via insurance portals and payer contact.
  • Identify primary/secondary insurances, including Private Insurance, Dependent Insurance, Medicare, and Medicaid plans.
  • Determine whether the case requires prior authorizations or referrals as per payer guidelines and document accordingly.
  • Review Coordination of Benefits (COB) and notify patients if updates are required.
  • Clearly communicate financial responsibilities to patients, including deductibles, co-pays, co-insurance, and update patient profiles accordingly.
  • Demonstrate proficiency in insurance verification portals such as Availity, Navinet, UHC, etc.
  • Ensure that insurance contracts and payer-specific agreements are taken into account during verification.
  • Maintain up-to-date and accurate patient demographic information in the billing/EMR systems.
  • Collaborate with patients and internal departments to gather all necessary information before scheduled appointments.
  • Liaise with insurance carriers directly when online eligibility verification is not possible.
  • Collect and forward eligibility, termination, and insurance resource information to the Billing Department for accurate claim processing.
  • Answer queries from patients, front-office staff, and insurance representatives regarding eligibility, benefits, and payment obligations.
  • Investigate and resolve patient or insurance-related complaints related to insurance verification or coverage issues.
  • Ensure strict compliance with HIPAA and patient confidentiality regulations.

The successful candidate will have:

  • Intermediate/A-levels and/or Bachelor's degree in Healthcare Administration, Finance, or a related field (preferred).
  • night shifts aligned with U.S. Central Time (7 PM – 4 AM PKT)
  • 1–2 years of experience in U.S. medical insurance verification, preferably in Psychiatry or Behavioral Health RCM.
  • Strong working knowledge of insurance verification processes, eligibility rules, COB, and prior authorization protocols.
  • Familiarity with insurance portals (e.g., Availity, Navinet, UHC Provider Portal, etc.).
  • Ability to interpret payer-specific guidelines and insurance contracts.
  • Proficient in using EMRs and medical billing systems.
  • Excellent communication skills (verbal and written) in English.
  • Proficiency in MS Excel, Google Sheets, and basic documentation/reporting tools.

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