Coverage Verification Specialist

We are seeking an experienced Coverage Verification Specialist to join the verification team of a U.S.

-based healthcare claims recovery company. This role confirms Motor Vehicle Accident (MVA) and Workers' Compensation coverage directly with insurance carriers, adjusters, and payer portals, so every account returned for billing is accurate, complete, and billable. This is a payer-only role, with no patient or provider contact.

The ideal candidate has 5+ years of U.S. healthcare payer-facing calling experience (insurance verification, AR follow-up, or claims), a clear and natural phone voice that U.S. adjusters trust, and the discipline to follow scripts and decision trees precisely.

Responsibilities:

• Review accounts with identified MVA or Workers' Compensation coverage and identify the correct payer, state rules, and script path before first contact.
• Use payer and carrier portals first, and call carriers and adjusters to confirm what portals cannot.
• Confirm coverage is active and applies to the date and circumstances of the accident or injury.
• Obtain and validate claim numbers, billing addresses, and claim submission details.
• Confirm policy information and limits when available or required, as well as adjuster and carrier contact details.
• Determine and document benefit/exhaust status and any attorney involvement.
• Resolve discrepancies between discovered coverage data and what the carrier confirms.
• Set and keep follow-up dates on every account that cannot be confirmed immediately.
• Escalate accounts the script cannot resolve to the Team Lead, with the full contact history attached.
• Log every carrier contact, portal search, result, and follow-up the same day.
• Return accounts only when every field needed for billing is complete and accurate.
• Handle all patient, claim, and payer information in line with HIPAA and confidentiality requirements.

Qualifications:

• 5+ years in U.S. healthcare revenue cycle, insurance verification, AR follow-up, or claims work, with most of the day spent on the phone with U.S. payers.
• Working knowledge of auto (PIP / Med Pay / bodily injury) and Workers' Compensation claims: claim numbers, dates of loss, adjusters, and benefit exhaustion.
• Clear, natural, professional spoken English; confident with hold queues, transfers, and asking for a supervisor.
• Disciplined script and decision-tree follow-through, with the judgment to know when to escal…
• Accurate, same-day documentation across multiple systems and payer portals.
• HIPAA-trained or experienced in handling protected health information (PHI).

Strongly Preferred:

• Third-party liability, MVA, or Workers' Compensation recovery experience for U.S. hospitals.
• Experience with Verisk or similar coverage-discovery data and major carrier/TPA portals.
• Familiarity with UB-04 / CMS-1500 bill types, AOB, and lien concepts.
• Experience on a multi-state account where rules differ by state.

Requirements:

• Updated Resume/CV.
• Available to work U.S. Eastern business hours (Philippine night shift).
• Willing to complete a recorded mock payer call as part of the screening process.
• Ability to work in a fast-paced, dynamic environment.
• Quiet workspace and a noise-canceling headset for VoIP calling.
• Reliable primary internet connection plus a backup connection, and a personal computer.
• UPS/battery backup to ensure continuity during power interruptions.
• WFH set-up.
• HMO.