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 .