Health Insurance Verification / Insurance Verification Specialist
Job Responsibilities:
- Provide enrollment assistance and guidance to Medicaid-eligible recipients and their families regarding the HIPP / Premium Assistance program via phone or correspondence.
- Verify, document, and investigate existing health coverage for Medicaid recipients and their dependents (employer plans, COBRA, etc.).
- Assist in identifying members who may qualify for HIPP / Premium Assistance.
- Obtain and verify documents required for eligibility: insurance policies, employment verification, premium invoices, etc.
- Maintain active case files during open enrollment cycles, premium review, and payment processing.
- Process, review, and follow up on premium payments / reimbursements, ensuring timely and accurate payments, and tracking any discrepancies.
- Perform ongoing case maintenance and audits, updating records for status changes, renewals, terminations, or escalations.
- Complete periodic reporting (e.g. case metrics, enrollment trends, audit reports) as required by state or internal stakeholders.
- Respond to high volumes of inbound and outbound calls and inquiries about eligibility, coverage, program rules, and status.
- Conduct advanced document review, legal research or case escalation as needed, particularly on more complex cases.
- Prioritize case events, manage deadlines, escalate issues to supervisors or subject matter experts when appropriate.
- Substantial customer service experience, ability to multi-task in a fast-paced environment, basic knowledge of health insurance and health insurance terminology, Excel Microsoft knowledge.
Skills:
- Insurance Verification
- Health Insurance
- Medicaid Verification
- Customer Service
- HIPPA
Education/Experience:
- Some colleges are desirable. A bachelor’s would be nice but not required.
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