Medical Insurance Verification Agent - U.S. Healthcare | EST Hrs
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 withi