Eligibility Specialist

UBC

Eligibility Specialist providing high-quality customer service to patients and client representatives in the healthcare support industry. Verify benefits and eligibility for therapy referrals and manage inquiries efficiently.

Posted 7/11/2026full-time🇺🇸 United StatesMid-LevelSeniorWebsite

About the role

Key responsibilities & impact

Provide the highest quality of customer service to patients and client representatives
Complete verification of Benefits and Eligibility for all referrals from patients, medical doctor’s office (MDOs), health plans and pharmaceutical manufacturers
Investigation of benefits and eligibility by phone and/or internet to determine coverage choices patient has in starting on therapy
Review incoming referrals for completeness of and confirm FDA requirements are met as applicable
Answer all Incoming calls quickly and efficiently, evaluate their need and respond or disseminate call to appropriate member of team
Provide assistance with reimbursement inquiry requests, including insurance benefit verification, prior authorization, denials and appeals, and other reimbursement issues from patients, MDOs, payers and Sales Representatives
May provide billing and coding information related to specific product(s)
Conduct general payer research
Participate in call center activities, triage, and respond to incoming calls from patients, insurance companies, physicians, sales representatives, pharmacies, and homecare agencies
May serve as single point of contact for an assigned group of prescribers
Effectively manage and work though action item list to ensure it is current and tasks are completed in a timely fashion
Maintain accurate and complete documentation of all inquiries in order to continuously improve the customer service process and reduce potential legal concerns
Identify and escalate repetitive questions and/or problems so that corrective action can be pursued and expedited
Responsible for good housekeeping techniques, adhering to quality and production standards while complying with all applicable company, state and federal safety and environmental programs and procedures
Other duties as assigned

Requirements

What you’ll need

High School diploma or equivalent
3-5 years’ experience in a customer service setting preferably in a call center environment
Previous experience in the PBM and or Healthcare Industry preferred
Computer proficiency in MS Office applications, with database experience preferred
Health insurance claims or patient accounting experience preferred
Knowledge of third-party billing, coding, medical terminology, prior authorizations and appeals preferred
Detail oriented with good analytical skills
Ability to manage multiple priorities and meet deadlines
Excellent written and verbal communication skills
Demonstrated ability to communicate with others at all levels
Excellent customer skills-patience to explain details and processes repeatedly
Excellent phone presentation skills
Demonstrated ability to handle challenging customers in a professional manner
Ability to adapt in a dynamic work environment and make decisions with minimal supervision
Advance problem solving skills and the ability to work collaboratively with other departments to resolve complex issues with innovative solutions
Ability to work a flexible schedule

Benefits

Comp & perks

Remote opportunities
Competitive salaries
Growth opportunities for promotion
401K with company match*
Tuition reimbursement
Flexible work environment
20 days PTO, accrued
Paid Holidays
Employee assistance programs
Medical, Dental, and vision coverage
HSA/FSA
Telemedicine(Virtual doctor appointments)
Wellness program
Adoption assistance
Short term disability
Long term disability
Life insurance
Discount programs

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Health Insurance ClaimsPrior AuthorizationsThird-Party BillingMedical TerminologyCodingPatient AccountingDatabase ExperienceDetail OrientationProblem SolvingDocumentation

Soft Skills

Excellent Communication SkillsPatienceAdaptabilityCollaborationProfessionalism