Benefit Investigation Analyst

Benefit Investigation Analyst

Required Skills & Experience: • 3+ years of healthcare benefits investigation, insurance verification, patient access, intake, authorization, or benefits navigation experience • Experience contacting national payers and verifying patient benefits and eligibility • Strong knowledge of Commercial and Medicare insurance plans • Experience interpreting coverage details, deductibles, co-insurance, and out-of-pocket responsibilities • Knowledge of healthcare insurance requirements, coverage policies, and payer guidelines • Experience working with TPAs (Third Party Administrators) • Strong communication, documentation, and organizational skills • Experience working in HIPAA-compliant healthcare environments • Experience utilizing CRM systems and managing patient information

Nice to Have Skills & Experience: • Salesforce CRM experience • Veteran Affairs payer experience • Authorization or reimbursement support experience • Knowledge of Medicare, Medicaid, and payer policy guidelines

Job Description: Conduct patient benefits investigations and eligibility verifications with national insurance payers and TPAs. Verify coverage, deductibles, co-insurance, and patient financial responsibility. Serve as the primary liaison between insurance payers and the sales organization. Accurately document benefit findings and communicate details to sales representatives. Support the patient onboarding process through timely and accurate insurance verification. Respond to benefit-related questions and escalations from sales and internal stakeholders. Maintain patient records and documentation within Salesforce and internal systems. Stay current on payer policies, coverage guidelines, and reimbursement requirements. Ensure compliance with HIPAA and healthcare regulatory standards. Partner with internal operations and authorization teams to support patient access to therapy.