Eligibility & Benefits Specialist

Role Overview

In this position, you serve as the first quality checkpoint before a claim is created. Your work ensures patient insurance details are confirmed accurately so that the rest of the revenue cycle can proceed without avoidable issues. During the day shift, you will rely on portals and APIs to confirm coverage at scale, with no room for guesswork. Every chart must be reviewed and validated before it moves ahead.

Key Responsibilities

• Use payer portals and API tools to confirm eligibility details, including demographics, insurance status, network participation, and date-of-service rules.
• Review each chart and classify it as approved, held, or denied based on the verification result.
• Check earlier coverage records to spot mismatches or inconsistencies before escalating a case.
• Pass unresolved or complicated cases to the night shift with complete notes and supporting documentation.

Performance Standard

The primary benchmark for this role is first-pass verification accuracy. The target is at least 98% of charts verified correctly without needing rework or escalation.

Work Approach

• Be meticulous and verify every chart instead of relying on assumptions.
• Follow a structured process, record outcomes clearly, and maintain consistency while handling volume.
• Think proactively by identifying issues early so the next shift receives clear, actionable cases.

Why This Role Matters

• Prevents incomplete submissions from moving forward and causing denials later in the process.
• Ensures missing documents, incomplete code validation, and skipped checks are caught at the start.
• Supports a day-shift model where only complete, accurate, submission-ready files are advanced.

Perks and Benefits

• Comprehensive training in eligibility verification, payer portals, and related workflows.
• Well-defined day-shift responsibilities with a clear operating structure.
• Exposure to the earliest stage of the revenue cycle.
• Coordinated collaboration with the night-shift team for execution support.
• A workplace culture that prioritizes accuracy at the very first step.

Qualifications

• A minimum of 1 year of experience in any field.
• A bachelor’s degree in any discipline.
• Preferred familiarity with healthcare or insurance processes.
• Strong attention to detail and accuracy in data validation.
• Clear communication skills for documentation and coordination.

Additional Information

This is a full-time, onsite role based in Vellore, Tamil Nadu, India. The position follows a day-shift schedule. Interested candidates can reach the employer by email at jobs@wonderws.co or by phone at 9047477375.