Clinical Insurance Specialist

9 hours ago

Quezon City, National Capital Region, Philippines beBeeInsurance Full time ₱350,000 - ₱550,000
Job Title

Clinical Insurance Specialist

A clinical insurance specialist performs intermediate level insurance verification and authorization duties with a growing level of responsibility. The position coordinates with clinical departments to ensure accurate scheduling for covered services, resolves moderate issues with payers, and supports pre-visit readiness for patients.

Key Responsibilities
  • Verify insurance coverage for outpatient and in-office procedures.
  • Identify and flag non-covered services or potential coordination of benefits issues.
  • Initiate and follow up on prior authorization requests, including appeals if necessary.
  • Maintain organized tracking logs for authorizations and coverage status.
  • Communicate coverage details to patients and collect out-of-pocket estimates if applicable.
  • Serve as a subject matter resource to staff.
  • Work insurance queues to resolve pre-service issues that may delay care.
  • Report payer trends or systematic verification issues to leadership.
Qualifications
  • Associate's degree preferred or equivalent work experience.
  • 3+ years of experience in a medical office or insurance verification role.
  • Strong understanding of commercial, government, and exchange-based insurance plans.
  • Familiarity with EMR systems.
  • Proficient in verifying coverage for high-cost services.
  • Excellent attention to detail and documentation skills.
Additional Requirement
  • Bilingual (Spanish/English)
About the Role

This is an opportunity to contribute to a team that values diversity and fosters an inclusive culture.

We provide space for everyone to thrive and grow, embracing different perspectives and making room for opportunities to succeed.

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