Job Title: Eligibility Agent (Insurance Eligibility Specialist)

 

About the Company:

Our Client is a healthcare organization focused on improving patient access to care through nutrition and preventative health services.

The company works with patients and healthcare providers to ensure a seamless experience by supporting eligibility verification, scheduling, and operational processes.

 

Job Description:

We are looking for an Eligibility Agent (Insurance Eligibility Specialist) to join Our Client's Patient Access and Operations team.

This role is responsible for verifying insurance eligibility, ensuring patients are financially cleared before scheduled consultations, and maintaining accurate insurance documentation across multiple systems.

The ideal candidate is detail-oriented, organized, and experienced in healthcare insurance verification. They thrive in a fast-paced remote environment, communicate effectively with internal teams, and are committed to maintaining accuracy and compliance in all aspects of their work.

 

Core Responsibilities:

• Verify insurance eligibility for scheduled patients to ensure active coverage before appointments.

• Review copays, deductibles, coverage limitations, and insurance discrepancies.

• Complete eligibility verification within required timelines to prevent disruptions in patient care.

• Communicate insurance-related issues, including inactive coverage, coverage discrepancies, or high out-of-pocket costs, to the appropriate teams.

• Flag cases that may require follow-up, rescheduling, or patient outreach.

• Collaborate with scheduling and operations teams to ensure patients are properly cleared.

• Accurately document eligibility verification results and insurance information in Zoho CRM.

• Update, edit, and maintain patient insurance records and files.

• Upload and manage documentation across platforms including Tebra and Sync.

• Maintain organized and compliant patient records.

• Monitor and respond to same-day eligibility verification requests.

• Support operational workflows to ensure timely scheduling and service delivery.

• Contribute to process consistency, efficiency, and accuracy.

 

Required Experience and Qualifications:

• At least 1 year of experience in insurance verification, eligibility, healthcare administration, or a related field.

• Familiarity with U.S. health insurance systems, including commercial insurance plans, Medicare, and Medicaid.

• Strong attention to detail and organizational skills.

• Excellent written and verbal communication skills in English.

• Ability to work independently in a remote environment.

• Ability to work the required early-morning schedule.

 

Preferred Skills:

• Experience using Zoho CRM, Tebra, or similar healthcare and CRM platforms.

• Experience working in telehealth or remote healthcare environments.

• Exposure to Medical Nutrition Therapy (MNT) or preventative care services.

• Strong problem-solving abilities and the ability to identify and resolve eligibility-related issues efficiently.

 

Personality:

• Highly detail-oriented and committed to accuracy.

• Accountable and dependable in completing time-sensitive tasks.

• Organized and capable of managing multiple priorities.

• Responsive and proactive when addressing eligibility issues.

• Collaborative team player with strong communication skills.

• Adaptable and comfortable working in a fast-paced environment.

• Patient-focused with an understanding of how eligibility accuracy impacts the patient experience.

 

Software & Tools:

• Zoho CRM

• Tebra

• Sync

• Insurance eligibility verification systems

• Healthcare documentation and patient record management platforms

 

Schedule:

Monday–Saturday, 2:00 AM–9:00 AM PST (or 3:00 AM–10:00 AM PST as needed)

 

Location:

100% Remote

 

Salary and Benefits:

Payment in USD or Local Currency according to candidate's preference.