Eligibility & Benefits Manager - AI Trainer
$105 per hourMercor
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
- For details about the interview process and platform information, please check:
- For any help or support, reach out to: View email address on ziprecruiter.com
PS: Our team reviews applications daily. Please complete your AI interview and application steps to be considered for this opportunity.
#hiringmercorVacancy posted 13 days ago
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