Health Insurance Verification / Insurance Verification Specialist

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.