Benefit Verification Specialist - AI Agents (Healthcare)

100ms is building AI agents that automate complex patient access workflows in U.S. healthcare, starting with benefits verification, prior authorization, and referral intake in specialty pharmacy. The team helps care teams reduce delays and administrative burden so that patients can start treatment faster, combining healthcare knowledge with LLM-based agents and robust ops infrastructure. The role is part of the operations team, helping verify insurance benefits for patients receiving specialty care in the U.S. This is a full-time, in-office role based in Bangalore, with partial overlap with US hours.

Responsibilities

Perform insurance verification and eligibility checks for commercial and government payers (e.g., Medicare, Medicare Advantage, Medicaid, Managed Medicaid, VA, DoD); Validate coverage details including deductibles, co-pay/coinsurance, network status, referrals, prior authorization requirements, and J-code/CPT-code specific benefits; Contact payer representatives via phone or payer portals as needed; Push back on payer based on previous experience; Accurately document findings in internal systems; Collaborate with internal teams to resolve missing or mismatched data; Collaborate with technology teams to improve data/systems; Ensure timely completion of verifications with high accuracy and within defined SLAs

Requirements

2+ years of experience in US healthcare insurance verification; Familiarity with payer portals (e.g., Availity, Navinet, Aetna, UHC); Understanding of insurance types (commercial, Medicare, Medicaid, HMO/PPO, etc.); Working knowledge of CPT codes, HCPCS, and payer-specific benefits rules; Strong attention to detail and ability to document accurately; Proficient in written and spoken English

Nice to have

Experience in specialty pharmacy, oncology, infusion therapy, or behavioral health; Background working with RCM platforms, EMRs, or AI-based automation tools