Medical Insurance Verification Agent - U.S. Healthcare | EST Hrs (Remote)

ISTA Personnel Solutions South Africa is a dynamic and fast-growing BPO company based in South Africa, specializing in providing top-tier operational support to US-based companies. We are not a recruitment agency; we are a dedicated extension of our clients' teams, delivering high-quality service with precision, efficiency, and a personal touch. 

We are looking for a Medical Insurance Verification Agent to join their team. This role is ideal for someone with previous U.S. healthcare or medical insurance experience, particularly experience with Verification of Benefits (VOB), eligibility verification, pre-authorizations or insurance authorizations.

The successful candidate will be responsible for verifying patient insurance benefits and, as the role develops, managing utilization review requests and following them through to approval.

PLEASE NOTE

• Working Hours: Monday to Friday, 8:00 AM – 5:00 PM EST | 2PM to 11PM (SAST), subject to change in accordance with daylight saving time.
• Internet Requirements: A dedicated, fixed FIBRE internet connection with a minimum speed of 25 Mbps upload and 25 Mbps download at your remote work location is mandatory. Connections via Rain, LTE, 5G, or similar are not acceptable. Applicants without a fixed fibre line will not be considered.
• Public Holidays: Required to work on all South African public holidays and will be compensated in accordance with the provisions of the Basic Conditions of Employment Act (BCEA).
• Power Backup: A reliable backup power solution that can support your equipment for the duration of your scheduled working hours during power outages (UPS, inverter, solar, etc.) is mandatory. Applicants without a reliable backup solution will not be considered.
• Work Environment: Fully remote within South Africa.

Duties & Responsibilities

Verification of Benefits (VOB)

• Verify patient insurance eligibility and benefits using U.S. insurance portals.
• Confirm that insurance coverage is active and identify relevant benefits and coverage information.
• Accurately capture and document verified insurance information.
• Upload and attach supporting documentation to the relevant patient record.
• Manage approximately 10–15 VOBs per day, while maintaining a high level of accuracy.
• Identify and communicate any discrepancies or issues with insurance coverage.

Utilization Review

• Retrieve and download relevant medical records from the patient management system.
• Prepare complete utilization review packets for submission to insurance providers.
• Submit authorization requests according to each payer's requirements, which may include email, fax or telephone.
• Follow up with insurance companies on pending authorization requests.
• Monitor authorization expiry dates and proactively request extensions where required.
• Maintain accurate records of authorization requests, follow-ups and outcomes.
• Take ownership of each request from submission through to obtaining a response and approval.
• Ensure that approvals are obtained within the required timeframes to prevent delays in patient care.

Requirements

• Previous experience within U.S. healthcare or U.S. medical insurance is essential.
• Excellent English communication skills — strong conversational fluency, comprehension and professional written communication are essential.
• Previous experience with insurance verification, eligibility, benefits, authorizations or pre-authorizations.
• Experience working with U.S. insurance portals and payer processes.
• Experience handling confidential medical and patient information.
• Previous Verification of Benefits (VOB) experience.
• Experience with Utilization Review (UR).
• Experience obtaining or following up on insurance authorizations.
• Experience in behavioural health, substance use treatment, ABA or another U.S. healthcare environment.
• Familiarity with U.S. commercial insurance and/or managed care.

If you are not contacted within 14 working days, please consider your application unsuccessful.