Health Insurance Verification / Insurance Verification Specialist

SGS_JOB_3391

Business Support
 Georgia
Insurance Verification
Health Insurance

Contract - 3 months

Location : Tucker, GA 30084 (Remote) Seeking professionals with experience in health insurance or Medicaid verification to support Medicaid-eligible members under the HIPP / Premium Assistance Program. The role involves insurance verification, eligibility documentation, case maintenance, and high-volume customer interaction

Job Responsibilities:

  • Provide enrollment assistance and guidance to Medicaid-eligible recipients and their families regarding the HIPP / Premium Assistance program via phone or correspondence.
  • Verify, document, and investigate existing health coverage for Medicaid recipients and their dependents (employer plans, COBRA, etc.).
  • Assist in identifying members who may qualify for HIPP / Premium Assistance.
  • Obtain and verify documents required for eligibility: insurance policies, employment verification, premium invoices, etc.
  • Maintain active case files during open enrollment cycles, premium review, and payment processing.
  • Process, review, and follow up on premium payments / reimbursements, ensuring timely and accurate payments, and tracking any discrepancies.
  • Perform ongoing case maintenance and audits, updating records for status changes, renewals, terminations, or escalations.
  • Complete periodic reporting (e.g. case metrics, enrollment trends, audit reports) as required by state or internal stakeholders.
  • Respond to high volumes of inbound and outbound calls and inquiries about eligibility, coverage, program rules, and status.
  • Conduct advanced document review, legal research or case escalation as needed, particularly on more complex cases.
  • Prioritize case events, manage deadlines, escalate issues to supervisors or subject matter experts when appropriate.
  • Substantial customer service experience, ability to multi-task in a fast-paced environment, basic knowledge of health insurance and health insurance terminology, Excel Microsoft knowledge.

Skills:

  • Insurance Verification
  • Health Insurance
  • Medicaid Verification
  • Customer Service
  • HIPPA

Education/Experience:

  • Some colleges are desirable. A bachelor’s would be nice but not required.

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