Medical Eligibility Specialists

Qualifications: Must have at least 1 year of BPO experience in customer service. Preferably with prior experience in insurance verification, especially in a dental orthodontic setting. Excellent attention to detail and data accuracy. Strong communication and interpersonal skills. Ability to work in a fast-paced, deadline-driven environment. Key Responsibilities: Review and verify patient insurance eligibility for orthodontic procedures via online portals or by phone. Confirm coverage details including plan type, orthodontic lifetime maximums, deductible, co-pay, coinsurance, and frequency limitations. Document all insurance information accurately in the patient management system. Communicate with insurance companies to clarify benefit details as needed. Flag and escalate issues such as ineligible coverage, policy terminations, or unusual plan exclusions. Coordinate with front office or scheduling teams to ensure patients are informed of their coverage prior to treatment. Maintain up-to-date knowledge of insurance providers’ policies and orthodontic codes (e.g., D8080, D8090). Meet performance standards for productivity, accuracy, and turnaround time.