Prior Authorization Specialist

Client Support Representative (AI Patient Access Specialist)

The Client Support Representative monitors AI-led conversations between healthcare representatives and insurance agents, guides the AI with accurate prompts and next steps, and seamlessly takes over when human interaction is required. This role sits at the intersection of healthcare administration, customer service, and machine learning, helping to verify insurance coverage, manage prior authorizations, and ensure that all information is captured and documented with precision. Typical call volume ranges from 10–20 calls per day, with most calls lasting around 5 minutes and more complex insurance verification calls extending up to 30–45 minutes.

Responsibilities

• Monitor AI-led agent-to-agent conversations between healthcare representatives and insurance agents to ensure accuracy and continuity.
• Drive AI interactions by selecting appropriate prompts, guiding responses, and determining next steps during each conversation.
• Take over calls when the AI cannot proceed, when an agent prefers to speak with a human, or when carrier or contract requirements mandate human interaction.
• Review notes from existing conversations and quickly pick up where another specialist or the AI left off, maintaining a seamless experience.
• Serve as the human-in-the-loop, teaching the AI system how to navigate the complexities of healthcare reimbursement and insurance processes.
• Verify insurance eligibility, benefits, and coverage details with a high level of accuracy and professionalism.
• Gather and document prior authorization information and conduct related follow-up with insurance agents and other stakeholders.
• Conduct insurance verification and follow-up activities to capture complete and accurate information before concluding calls.
• Maintain detailed notes during and after each conversation, ensuring all relevant information is captured and clearly documented.
• Accurately document insurance verification and prior authorization details in internal systems and tools.
• Review all information for completeness and accuracy before closing interactions or moving on to the next task.
• Manage both outbound and inbound call workflows while maintaining quality, accuracy, and adherence to established processes.
• Navigate multiple systems and screens efficiently during calls to access, update, and verify information.
• Follow established workflows, directions, and processes to ensure consistent handling of insurance verification and prior authorization tasks.
• Collaborate with AI-driven technology and adapt to evolving tools, prompts, and workflows as the system improves.
• Provide a high level of customer service and professionalism in all interactions with insurance agents and healthcare representatives.
• Apply strong listening, comprehension, and communication skills to understand context from previous notes and continue conversations seamlessly.
• Support process improvement efforts by consistently applying best practices and identifying opportunities to enhance accuracy and efficiency.

Essential Skills

• High School Diploma or GED.
• Basic computer proficiency and the ability to learn new systems and technology quickly.
• Proven data entry and documentation skills with strong attention to detail.
• Experience navigating multiple systems and screens while handling calls and documentation.
• Customer service experience of at least 6 months in a call center, client support, or similar environment.
• Strong listening, comprehension, and verbal communication skills.
• Ability to provide a high level of customer service and professionalism in all interactions.
• Ability to work independently while following directions and established processes.
• Solution-oriented mindset focused on resolving issues and moving conversations forward.
• Ability to quickly absorb information from previous notes and continue a conversation without missing critical details.
• Coachable and adaptable approach to new technology, AI tools, and evolving workflows.
• Demonstrated ability to manage both inbound and outbound calls while maintaining quality and accuracy.
• Comfort working with AI-led conversations and acting as the human-in-the-loop in a technology-enabled environment.

Additional Skills & Qualifications

• Experience in healthcare administrative or customer service roles, such as Healthcare Receptionist, Medical Office Assistant, Healthcare Call Center Representative, Patient Access Representative, Pharmacy Technician or Support, Medical Administrative Assistant, or Healthcare Internship.
• Recent college graduates with strong communication and technology skills are encouraged to apply.
• Knowledge in health care, insurance verification, or prior authorization support is highly beneficial.
• Experience in call center, customer support, customer care, or client services environments.
• Familiarity with call monitoring and call support functions.
• Experience with documentation and data entry management in a professional setting.
• Proficiency with Microsoft Office and related productivity tools.
• Experience in administrative support or front desk roles where accuracy and professionalism are critical.
• Ability to contribute to process improvement initiatives and adopt best practices as workflows evolve.
• Comfort working in a remote environment with AI-driven tools and multiple digital platforms.

Work Environment

This is a remote role based in the United States, with candidates required to reside in one of the following states: Florida, North Carolina, Texas, Utah, South Carolina, Wisconsin, Georgia, Indiana, or Delaware. The position operates in a modern, AI-enabled contact center environment focused on healthcare access, insurance verification, and prior authorization support. Team members typically handle 10–20 calls per day, working on one AI-supported conversation at a time to ensure detailed, accurate documentation and high-quality interactions. The work involves extensive use of computers, multiple software systems, and AI-driven tools, including internal documentation platforms and Microsoft Office. The culture emphasizes creating time for healthcare by improving access, adherence, and affordability, with a strong focus on coordination between patients, providers, and payers. Professionals in this environment collaborate with advanced technology while maintaining a patient-centered mindset, and they are expected to demonstrate professionalism, adaptability, and attention to detail in a remote setting.

Job Type & Location

This is a Contract position based out of San Francisco, CA.

Pay and Benefits

The pay range for this position is $20.00 - $20.00/hr. Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a fully remote position.

Application Deadline

This position is anticipated to close on Sep 4, 2026.