Eligibility & Benefits Manager - Remote | Upto $105/hr

Job Description

Job Description

About the job

Mercor connects elite creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include Benchmark , General Catalyst , Peter Thiel , Adam D'Angelo , Larry Summers , and Jack Dorsey .

Position: Insurance Verification & Benefit Manager
Type: Contract
Compensation: $105/hour
Location: Remote

Role Responsibilities

• Oversee insurance verification, eligibility determination, and benefits investigation workflows across commercial, Medicare, Medicaid, and managed care payers.
• Verify patient insurance coverage using payer portals, clearinghouses, and EDI 270/271 real-time eligibility transactions.
• Identify and resolve coordination of benefits issues, coverage gaps, and eligibility discrepancies prior to service delivery.
• Evaluate and annotate AI-generated eligibility verification outputs for accuracy, completeness, and payer compliance.
• Develop and document SOPs for eligibility and benefits verification workflows.
• Monitor KPIs including verification accuracy rates, front-end denial rates related to eligibility, and turnaround times.
• Ensure compliance with payer-specific requirements, CMS guidelines , and HIPAA regulations .
• Identify process gaps and recommend workflow improvements to reduce eligibility-related claim denials.
• Provide structured feedback and annotations to support AI training datasets .

Qualifications

Must-Have

• 5+ years of experience in insurance verification, eligibility and benefits management, or front-end revenue cycle operations, with at least 2 years in a management role.
• Expert knowledge of EDI 270/271 transactions , payer portal navigation, and real-time eligibility tools.
• Strong familiarity with Medicare, Medicaid, and commercial payer eligibility requirements and benefit structures.
• Proficiency with Epic , Cerner , Meditech , or equivalent EHR platforms .
• Experience with clearinghouse platforms such as Availity , Change Healthcare , or similar.
• Exceptional written and verbal English communication skills.
• High attention to detail with the ability to identify subtle discrepancies in coverage data.

Preferred

• CHAM , CHAA , or equivalent front-end revenue cycle certification.
• Experience with automated eligibility verification tools and RPA solutions .
• Background in denial root cause analysis related to eligibility and coverage errors.
• Familiarity with AI tools and comfort evaluating AI-generated healthcare content.
• Experience presenting eligibility performance data to senior leadership.

Application Process (Takes 20–30 mins to complete)

• Upload resume
• AI interview based on your resume
• Submit form

Resources & Support

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PS: Our team reviews applications daily. Please complete your AI interview and application steps to be considered for this opportunity.