Insurance Verifications Specialist

Job Brief:

As an Insurance Verification Specialist, you are responsible for verifying patients' insurance eligibility, benefits, and coverage for the Patient Access Programs. You will utilize all available resources, including internal systems, payer portals, and direct communication with insurance carriers, to accurately complete benefit investigations and ensure timely patient access to Eversense Continuous Glucose Monitoring (CGM) services.

This role serves as the primary point of contact for the Eligibility and Benefits process, requiring close coordination with insurance payers, healthcare providers, patients, and internal teams. You will identify payer-specific requirements, coverage guidelines, plan limitations, and reimbursement criteria to support efficient case progression and resolution.

The ideal candidate possesses strong knowledge of insurance verification processes, including Medicare, Medicaid, Managed Care, and Commercial plans. Success in this role requires critical thinking, attention to detail, problem-solving skills, and the ability to resolve coverage issues, discrepancies, and other barriers that may impact patient access.

You must be highly proficient in navigating payer portals, conducting payer outreach, documenting insurance findings, and maintaining compliance with quality standards. The role requires effective management of a high-volume caseload while ensuring accuracy, productivity, and excellent customer service.

As part of the DME Serve team, you will contribute to improving patient access to healthcare while collaborating with Operations, Quality, Training, and Client Services teams. You will also have access to ongoing professional development, learning opportunities, and competitive benefits within a patient-focused organization committed to service excellence.

Job Duties and Responsibilities:

• Verify patient insurance eligibility, benefits, coverage, and authorization requirements for EON Care and Senseonics Patient Access Programs.


• Conduct comprehensive benefit investigations using payer portals, insurance carrier systems, and direct communication with payers.


• Determine plan-specific requirements, coverage guidelines, limitations, and reimbursement criteria.


• Coordinate with insurance representatives, healthcare providers, patients, and internal teams to ensure timely case progression and resolution.


• Review and validate insurance information for Medicare, Medicaid, Managed Care, and Commercial health plans.


• Identify, research, and resolve benefit discrepancies, coverage issues, and payer-related barriers affecting patient access.


• Document all insurance verification activities, payer communications, reference numbers, and case updates accurately within designated systems.


• Maintain detailed and compliant records in accordance with company policies, client requirements, and regulatory standards.


• Manage a high-volume caseload while meeting established productivity, quality, and turnaround time metrics.


• Follow up on pending cases and escalate complex issues as necessary to ensure timely outcomes.


• Utilize all available tools and resources to maximize efficiency and improve the patient access experience.


• Deliver exceptional customer service while maintaining professionalism and confidentiality.

Qualifications

Preferred Qualifications

• Experience supporting Durable Medical Equipment (DME), Medical Devices, CGM, Specialty Pharmacy, or Patient Access programs.


• Knowledge of Eligibility and Benefits, prior authorization, reimbursement, and patient financial assistance processes.


• Familiarity with healthcare compliance standards, HIPAA regulations, and insurance industry guidelines.


• Experience working with EHR, CRM, or case management systems.


• Startup / rapid growth experience, biotech, life sciences, pharmaceutical, or medical device industry experience.


• Experience supporting provider offices, specialty clinics, or payer-facing healthcare programs.


• Experience with medical RCM LOBs like Eligibility and Benefits or Insurance Verification, and any related LOBs.

• High attention to detail and documentation accuracy


• Ability to manage high volume workloads and meet performance targets


• 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.

Key Competencies

• Customer Focus


• Accountability


• Attention to Detail


• Time Management


• Problem Solving


• Collaboration


• Adaptability


• Results Orientation


• Professional Communication


• Quality and Compliance Focus

Payer Portal Management

• Navigate and manage multiple payer portals (All Types of Insurances/Payers) simultaneously to check, investigate, and confirm coverage.


• Maintain proficiency across various insurance carrier websites and authorization platforms.


• Interpret payer-specific guidelines, submission requirements, and portal workflows.


• Prioritize cases effectively across multiple payer systems while maintaining productivity and accuracy.


• Document all payer interactions, reference numbers, and any activities to related systems/tools.

Documentation & Compliance

• Ensure complete and accurate documentation is maintained within designated systems, EHRs, CRMs, and patient tracking platforms.


• Maintain audit-ready records of all authorization activities.


• Comply with HIPAA regulations, client requirements, and internal compliance standards.


• Participate in quality reviews, audits, and continuous improvement initiatives.

Required Qualifications

• High School Diploma or equivalent; Associate's or Bachelor's degree preferred.


• Minimum 2 years of experience in Insurance Verification, Benefit Investigation, Patient Access, Revenue Cycle, or a related healthcare support role.


• Strong working knowledge of Medicare, Medicaid, Managed Care, Commercial Insurance, and payer-specific policies.


• Experience navigating multiple payer portals and insurance verification platforms.


• Excellent verbal and written communication skills.


• Strong analytical, critical thinking, and problem-solving abilities.


• Ability to research and interpret insurance benefits, coverage policies, and reimbursement requirements.


• Proficiency in Microsoft Office applications and healthcare-related systems.


• Strong attention to detail, organizational skills, and accuracy in documentation.


• Ability to manage multiple priorities in a fast-paced, high-volume environment.

Technical Requirements

• Proficiency in Microsoft Office Suite, including Outlook, Excel, and Word.


• Experience using electronic health records (EHR/EMR), payer portals, CRM systems, and patient management platforms.


• Ability to manage multiple browser-based payer systems efficiently.


• Typing speed of at least 35 WPM with strong accuracy.


• Experience using and navigating IVRs from Payers/Insurance and providers office.