Claims Evaluator

4 days ago

Karachi, Sindh, Pakistan beBeeInsurance Full time
Insurance Verification Specialist

This is a full-time, onsite position designed to support the insurance verification process for Psychiatry and Behavioral Health billing under U.S. healthcare systems.

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.

The ideal candidate should have a strong command of insurance portals, an understanding of payer-specific rules, and be comfortable communicating with patients, payers, and internal teams.

  • 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.

Requirements:

  • An intermediate degree and/or Bachelor's degree in Healthcare Administration, Finance, or a related field (preferred).
  • Night shifts aligned with U.S. Central Time (8 PM – 4 AM PKT)
  • 1–2 years of experience in U.S. medical insurance verification, preferably in Psychiatry or Behavioral Health RCM.
  • A 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.

  • Credentialing Specialist

    3 days ago

    Karachi, Sindh, Pakistan Claims Med Full time

    Claims Med pioneers in Medical Services for Healthcare providers in the United States. We are looking for fresh, energetic individuals who can not only add value to our institution, but also find endless opportunities in a growing firm.We are currently hiring for a Provider Credentialing Officer and looking for candidates who are willing to learn and apply...

  • Assistant Manager- Claims Doctor

    2 weeks ago

    Karachi, Sindh, Pakistan EFU Life Assurance Ltd. Full time

    1 day ago Be among the first 25 applicantsDirect message the job poster from EFU Life Assurance Ltd.Company DescriptionEFU Life is the leading Life and Health Insurer and Family Takaful operator in the private sector of Pakistan. Having started operations in 1992 as the first private sector life insurance company, EFU Life has established itself as a trusted...

  • Manager – Insurance

    2 days ago

    Karachi, Sindh, Pakistan Sui Southern Gas Company Limited Full time

    Master's degree in Finance, Insurance, or Risk Management (18 years of education) from an HEC-recognized university with at least 4 years of experience.Insurance-related professional qualifications such as Dip CII, ARM, or CPCU are preferred.Responsibilities:Job SummaryThe main purpose of this position is to support the section head in arranging adequate...

  • Senior Insurance Specialist

    1 day ago

    Karachi, Sindh, Pakistan beBeeInsurance Full time

    Job Title: Insurance Risk ManagerJob Summary:The primary objective of this position is to collaborate with the section head in arranging adequate insurance coverage for company assets and employees at minimal cost. The incumbent is also accountable for policy administration, underwriting, claims management, and recoveries in cases of damages.Key...

  • Manager – Insurance

    7 days ago

    Karachi, Sindh, Pakistan Sui Southern Gas Company Limited Full time

    Get AI-powered advice on this job and more exclusive features.Master's degree in Finance, Insurance or Risk Management (18 years of education) from HEC recognized University with at least 4 years of experienceInsurance related professional qualification Dip CII, ARM or CPCU will be preferred.Job SummaryThe main purpose of this position is to support section...

  • Manager - Training and Development

    2 weeks ago

    Karachi, Sindh, Pakistan Waada Full time

    4 days ago Be among the first 25 applicantsGet AI-powered advice on this job and more exclusive features.Direct message the job poster from WaadaHRM | Technical Recruitment | Talent Acquisition | HR Ops | OnboardingSummary:Waada Digital is looking for an experienced and motivated Training Manager to lead the design and delivery of comprehensive training...

  • Assistant Manager and executive

    2 weeks ago

    Karachi, Sindh, Pakistan Mitaas (Pvt) Limited Full time

    Assistant Manager and Executive - Export SalesResponsibilities:Formulate annual and monthly sales plan and implement sales strategy.Monitor market trends to identify business opportunities.Negotiate with suppliers.Oversee collection of payment, manage debtors and customer claims.Oversee all customer feedback in order to enhance customer service.Review and...

  • Assistant Manager HR Operations

    3 days ago

    Karachi, Sindh, Pakistan Martin Dow Limited Full time

    Assistant Manager HR Operations - Compensation And BenefitA fast growing pharmaceutical company of repute is looking for Assistant Manager HR Operations - Compensation and Benefit. The position will be responsible for managing compensation and benefit programs, ensuring equity of salary and benefits within grades, supervising payroll process and accrued...

  • Deputy Chief Manager – Complains

    3 weeks ago

    Karachi, Sindh, Pakistan Sui Southern Gas Company Limited Full time

    CA / ACMA with at least 04 years of post-qualification experience or ACCA / MBA with at least 06 years of experience. Must have experience of Rules & Regulations of Regulatory Framework.Responsibilities:Review of responses on consumer complaints received from OGRA while ensuring compliance with standard rules and regulations.Evaluate Passing Unregistered Gas...

  • HR Manager

    3 days ago

    Karachi, Sindh, Pakistan Protege Global Full time

    Maintains and enhances the organization's human resources by planning, implementing, and evaluating employee relations and human resources policies, programs, and practices. This person will be the head of HR team and responsible for managing all the activities of HR in all the three locations. Human Resource Manager Job Duties: • Maintains the work...