Insurance Verification Specialist

4 weeks ago

Brookfield WI United States Optum Full time

Our office is located at Brookfield, WI. If you are located within commutable distance of the office, you may opt to work onsite, otherwise, you may enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.


Opportunities with ProHealth Care, part of the Optum family of businesses. ProHealth Care is proud to be a leader in health care services, serving Waukesha County and the surrounding areas for more than a century. Explore opportunities across the full spectrum of care as you help us improve the well-being of the community with your skills, compassion, and innovation. Be part of a collaborative environment that strives for excellence, nurtures respect, and ensures high-quality care delivery to our patients. Join us in making an impact and discover the meaning behind Caring. Connecting. Growing together.


The Insurance Verification Specialist provides detailed and timely communication in order to facilitate compliance with payer contractual requirements and is responsible for documenting the appropriate information in the patient's record. They ensure preauthorization and referral requirements are met prior to the delivery of system services that require authorization.


This position is full-time. Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8am - 4:30pm CST. It may be necessary, given the business need, to work occasional overtime. Our office is located at 2085 North Calhoun Road Brookfield WI 53005.


We offer weeks of paid on-the-job training. The hours during training will be 8am to 4:30pm, Monday - Friday. Training will be conducted virtually from your home.


*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.


Primary Responsibilities:



  • Demonstrate strong knowledge of insurance requirements including processing of all referrals requiring authorization based on plan & type of referral.
  • Initiate contact w/ payers to complete insurance verification activities to prevent delays in care due to missing authorizations.
  • Use critical thinking to troubleshoot & contact payers and patients as necessary to secure coverage & authorizations prior to services being rendered.
  • Navigate EMR,insurance portals/protocols associated with each payer for authorization activities, including identifying & providing all relevant clinical information to support the authorization.
  • Document all authorization related information using medical terminology appropriate to the service in the EMR to support continuity of care. Includes information gathered during the verification or authorization process.
  • Update health record w/ accurate information regarding insurance coverage based on information gathered during verification &/or authorization process.
  • Obtain required authorizations, pre-certifications and 2nd opinion surgical approval for inpatient/out-patient procedures for multiple service lines, depts & modalities across the continuum. Identify/escalate barriers to obtaining authorization to the insurance company or per dept protocol.
  • Respond to insurance company inquiries for information. Includes consent forms, pre-authorization forms, 2nd opinion forms & referral forms.
  • Coordinates w/ providers, payers, depts, & patients regarding authorization status and options & documents outcomes in the EMR.
  • Confirms payment coverage including the initiation of insurance & managed care authorizations.
  • Communicates w/ providers & clinical delegates to resolve any outstanding information regarding preauth & referral requirements.
  • Perform electronic eligibility confirmation as needed; verify insurance for encounters & visits as assigned.
  • Completes assigned tasks in EMR work queues & brings work lists to completion.
  • Generates forms to insurance companies: consent , pre-authorization, second opinion and referral. Provides outcome of requested surgery/procedure order referrals to requesting MD/nurse & patient when applicable.
  • Notify provider of denied procedure/request for peer to peer discussion with insurance company & adjust authorization status accordingly.
  • Works independently & as part of a team in conjunction with Utilization Review/other depts as necessary to provide appropriate clinical information from the EMR in order to appeal the denials from the insurance company to secure financial payments.
  • Follow-up on discharge status of patients & relay information to insurance carriers as they require.
  • Actively participates in identifying/implementing improvements of department/organizational processes to more efficiently & effectively meet business objectives & educate staff as appropriate.
  • Accountabilities include completion of compliance requirements, achievement of productivity standards, & maintenance of competency levels/quality standards as defined by the organization.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:



  • High School diploma / GED
  • Must be 18 years of age and older
  • 3+ years experience in medical billing, medical insurance verification, managed care and/or patient registration
  • 3+ years experience of health insurance plans including Medicare, Medicaid and commercial carriers
  • 3+ years experience working with an EMR system
  • 3+ years of prior authorization experience
  • 3+ years of surgical authorization experience
  • Ability to work full-time. Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8am - 4:30pm CST. It may be necessary, given the business need, to work occasional overtime.

Preferred Qualifications:



  • 1+ years experience in an acute care billing/insurance verification/managed care/registration department.
  • Previous experience with prior authorizations and referrals strongly preferred
  • Previous experience with Epic medical record and medical terminology preferred

  • Epic experience
  • Reside within 2085 North Calhoun Road Brookfield, WI

Telecommuting Requirements:



  • ..Job text has been truncated here but will be shown when you apply.

  • Insurance Verification Specialist

    4 weeks ago

    Brookfield, Wisconsin, United States Optum Full time

    Our office is located at Brookfield, WI. If you are located within commutable distance of the office, you may opt to work onsite, otherwise, you may enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges. Opportunities with ProHealth Care, part of the Optum family of businesses. ProHealth Care is proud to be a...

  • Insurance Specialist

    2 days ago

    Madison, WI, United States TRICOR Insurance Full time

    Do you have EXCELLENT customer service skills? Do you LOVE working with people, listening to their needs, and recommending solutions to help them? Are you an independent, dependable self-starter who is really good at managing and prioritizing your day & tasks? Do you have strong administrative skills - including computer skills, written & verbal...

  • Life And Health Insurance Professional

    2 days ago

    Madison, WI, United States TRICOR Insurance Full time

    Do you have EXCELLENT customer service skills? Do you LOVE working with people, listening to their needs, and recommending solutions to help them? Are you an independent, dependable self-starter who is really good at managing and prioritizing your day & tasks? Do you have strong administrative skills - including computer skills, written & verbal...

  • Insurance Service Specialist

    3 weeks ago

    Windsor, CT, United States Great American Insurance Group Full time

    Be Here. Be Great. Working for a leader in the insurance industry means opportunity for you. Great American Insurance Group's member companies are subsidiaries of American Financial Group. We combine a "small company" culture where your ideas will be heard with "big company" expertise to help you succeed. With over 30 specialty and property and casualty...

  • INSURANCE SPECIALIST

    3 days ago

    Camden, NJ, United States Cooper University Health Care Full time

    About us At Cooper University Health Care, our commitment to providing extraordinary health care begins with our team. Our extraordinary professionals are continuously discovering clinical innovations and enhanced access to the most up-to-date facilities, equipment, technologies and research protocols. We have a commitment to its employees by providing...

  • Patient Support Specialist

    4 days ago

    Middleton, WI, United States Chartwell Midwest Full time

    POSITION SUMMARYThe duties of the Patient Support Specialist are similar to those of the Patient Support Representativeas outlined in this position summary. They differ in that the Specialist works in areas of HME with ahigher degree of complexity (e.g. Complex RT, General HME). The Patient Support Specialist isresponsible for the collection of demographic...

  • PATIENT ACCESS SPECIALIST; 0.8 FTE; DAY SHIFT

    3 weeks ago

    , WI, United States Meriter-UnityPoint Health Full time

    13382BRDepartment Name:HSP Patient Registration Location:Meriter Hospital Job Description: $1,500 Sign on Bonus Eligible! The Patient Access Specialist is responsible for establishing and maintaining complete patient records within the Epic System, including all patient demographic information, and insurance information to establish a clean claim, and to...

  • INSURANCE SPECIALIST

    4 days ago

    Camden, NJ, United States Cooper University Health Care Full time

    About us At Cooper University Health Care, our commitment to providing extraordinary health care begins with our team. Our extraordinary professionals are continuously discovering clinical innovations and enhanced access to the most up-to-date facilities, equipment, technologies and research protocols. We have a commitment to its employees by providing...

  • Insurance Agent: 2-20 or 4-40

    2 weeks ago

    palmetto, FL, United States AMISTAD INSURANCE LLC Full time

    Currently hiring full time positions for Customer Service Insurance Sales Agents.· We are looking for aggressive customer service salespeople with the desire to build a career. This is a great opportunity for someone who is looking to make a good income with job stability.· We have more leads than we can handle. We will train the right person to convert...

  • Insurance Billing Specialist

    2 weeks ago

    North Canton, OH, United States Absolute Companies Full time

    Insurance Billing Specialist | Insurance DivisionBilling | Reimbursement SpecialistPOSITION SUMMARY:The Billing Reimbursement Specialist is responsible for ensuring cash flow for services provided. The individual in this position may cross train in more than one area of A/R Management. In general, the Representative is responsible for communicating...

  • Insurance Agent: 2-20 or 4-40

    4 days ago

    Bradenton, FL, United States AMISTAD INSURANCE LLC Full time

    Currently hiring full time positions for Customer Service Insurance Sales Agents.· We are looking for aggressive customer service salespeople with the desire to build a career. This is a great opportunity for someone who is looking to make a good income with job stability.· We have more leads than we can handle. We will train the right person to convert...

  • Accounts Payable Specialist

    4 weeks ago

    Brookfield, United States Common Ground Healthcare Cooperative Full time

    Job DescriptionJob DescriptionAccounts Payable SpecialistAbout usCommon Ground Healthcare Cooperative is a "who" not a "what." As a cooperative, we are thousands of Wisconsin residents buying health insurance together, supported by a staff focused on providing the best possible service to our members. We are a not-for-profit cooperative, governed by a Board...

  • PATIENT ACCESS SPECIALIST

    2 weeks ago

    , TN, United States Covenant Health Inc. Full time

    Overview Patient Access Specialist, Centralized Scheduling Full time, 80 hours per pay period, Day shift Covenant Health Overview: Covenant Health is East Tennessee's top-performing healthcare network with 10 hospitals (http://www.covenanthealth.com/hospitals/) and over 85 outpatient and specialty services (http://www.covenanthealth.com/services/) , and...

  • PATIENT ACCESS SPECIALIST 1

    3 weeks ago

    , FL, United States The Tampa General Hospital Foundation Inc Full time

    Job Summary:Patient Access Specialists are responsible for guiding patients through the visit process by screening patients for eligibility, preparing patient information for clinical staff, and answering patient questions. The role provides high-level administrative support to the patient access team, including completion of patient medical insurance...

  • Tech Support Specialist

    6 days ago

    Brookfield, United States The Howard Company, Inc Full time

    The Howard Company is the Nation’s leader in drive-thrus, digital displays and menu boards. We are an employee-owned company, celebrating over 70 years of design excellence. **Why Work for US?** - 100% Employee-owned - Opportunities for advancement and promotions from within - Known as a leader in our field - Work-life balance - Work culture committed to...

  • Insurance & Membership Specialist

    2 weeks ago

    Santa Fe, NM, United States AAA New Mexico Full time

    Insurance & Membership SpecialistWell Known AAA Brand Products and ServiceExcellent Earning PotentialPaid TrainingIf you are a career-minded, service-driven professional looking to join a fast-paced organization then you have come to the right place. This is an exciting entry level position in our branch network and ideal for candidates interested working in...

  • Medical Billing Specialist

    1 month ago

    Brookfield, United States Fusion Anesthesia Solutions Full time

    **Experienced Medical Billing Specialist** This is a Remote Hybrid position. Employees work remotely, with required monthly, scheduled IN-office day(s) assigned by direct management. Growing medical billing office seeking Experienced Medical Billing Specialist to join our ever-expanding company. Work as part of a Team handling multiple areas of the...

  • Logistics Specialist

    1 week ago

    Brookfield, United States Rausch Sturm Full time

    Come join our team! Rausch Sturm LLP, a creditor's rights law firm, located in Brookfield, WI is interested in YOU potentially joining our team. This logistics specialist position is primarily administrative in nature and will perform functions within our mailroom, such as scanning, document processing, and mailings. The right candidate will also be...

  • Insurance & Membership Specialist

    3 weeks ago

    Albuquerque, NM, United States AAA New Mexico Full time

    Insurance & Membership SpecialistWe are looking for someone who will thrive in a sales and service environment. We’ll provide the training you need on an array of AAA products and services to interface with members with confidence. This training will help you meet your individual and team cross-selling and upselling goals. You’ll also have the...

  • PAS Homecare Intake Specialist

    1 day ago

    Farmington, CT, United States Hartford HealthCare Full time

    Work where every moment matters. Every day, over 38,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut's most comprehensive healthcare network. The creation of the HHC System Support Office recognizes the work of a large and growing...