Benefits Investigation and Eligibility Specialist

Baylor Genetics

. Verify active primary, secondary, and tertiary insurance coverage, including member details, demographics, effective dates, plan type, payer information, and coordination-of-benefits requirements .

Posted 9/15/2026full-timeRemote • United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in healthcare insurance verification and benefits investigation, with a strong focus on accuracy, attention to detail, and compliance with HIPAA regulations. Proficient in using payer portals and electronic eligibility tools to manage patient information and resolve discrepancies effectively.

Highest-signal resume keywords

Healthcare Insurance VerificationPayer Portals ExperienceStrong Problem-Solving SkillsAttention to DetailHIPAA Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Insurance Coverage VerificationBenefits InvestigationData Entry AccuracyPrior Authorization KnowledgeRevenue Cycle Management

Soft Skills

Strong Written CommunicationStrong Verbal CommunicationIndependent Work AbilityTime ManagementPatient-Centered Approach

Tools & Technologies

QuadaxSalesforceElectronic Eligibility ToolsHealthcare SystemsPayer Portals

Industry Keywords

Commercial InsuranceMedicareMedicaidManaged Care PlansGenetic Diagnostics

About the role

Key responsibilities & impact

Verify active primary, secondary, and tertiary insurance coverage, including member details, demographics, effective dates, plan type, payer information, and coordination-of-benefits requirements
Use payer portals, electronic eligibility tools, and direct payer contact to validate coverage and resolve insurance discrepancies
Contact patients and provider offices to obtain missing or corrected insurance information and escalate unresolved issues
Investigate benefits for genetic and molecular diagnostic services, including deductibles, copayments, coinsurance, out-of-pocket amounts, benefit limitations, and network requirements
Identify prior authorization, notification, referral, medical records, and other payer requirements
Route cases to the appropriate team with complete supporting information
Document benefit findings, payer representatives, reference numbers, call dates, portal results, and follow-up actions accurately
Communicate eligibility and benefit findings clearly without making coverage guarantees
Manage assigned work queues independently, prioritize time-sensitive cases, follow up within established turnaround times, and meet productivity and quality expectations
Research and resolve routine issues, review work for accuracy and completeness, maintain auditable documentation, and escalate payer, system, or policy issues
Participate in training, quality reviews, and workflow improvements
Protect patient, client, financial, and company information in accordance with HIPAA and Baylor Genetics policies
Perform other job-related duties as assigned

Requirements

What you’ll need

High school diploma or equivalent
2+ years of experience in healthcare insurance verification, benefits investigation, patient access, revenue cycle, or a related function
Working knowledge of commercial insurance, Medicare, Medicaid, and managed care plans
Experience using payer portals, electronic eligibility tools, and healthcare or revenue cycle systems
Ability to work independently, research issues, make sound decisions within established procedures, and escalate appropriately
Strong problem-solving skills and ability to resolve incomplete, conflicting, or unclear insurance information
Exceptional attention to detail and accuracy in data entry, documentation, and follow-up
Strong written and verbal communication skills with a professional, patient-centered approach
Ability to manage multiple cases and priorities in a production-based environment
Ability to handle protected health information and confidential financial information appropriately
Preferred: Associate degree in healthcare administration, business, or a related field
Preferred: Experience in diagnostic laboratory, genetics, molecular diagnostics, pathology, or specialty healthcare
Preferred: Experience with Quadax, Salesforce, clearinghouses, payer portals, or similar systems
Preferred: Familiarity with prior authorization workflows, payer medical policies, and patient financial responsibility
Compliance with HIPAA, Baylor Genetics policies, and applicable payer and regulatory requirements