Insurance Specialist, Medellín
Hybrid – Full-Time

We are a growing healthcare organization focused on delivering high-quality, patient-centered care through efficient, compliant, and financially sustainable clinical operations. Our teams support specialized medical practices and rely on accurate insurance verification and timely authorizations to ensure patients receive seamless care without financial risk. As we continue to scale, we are seeking detail-oriented professionals who take ownership of the insurance lifecycle and thrive in regulated, on-site environments.

We are currently seeking an Insurance Specialist to manage the end-to-end verification and authorization process. This role is a critical link between clinical documentation, insurance payers, and patient access, ensuring that every procedure is backed by confirmed coverage and medical necessity.

Position Summary

As an Insurance Specialist, you will serve as a key liaison between healthcare providers, insurance companies, and patients. Your primary mission is to ensure patients receive timely access to care by verifying benefits, securing prior authorizations, and communicating coverage details clearly. This role requires a deep understanding of payer guidelines, medical terminology, and a proactive approach to resolving denials or documentation gaps to support both patient health and practice efficiency.

What You’ll Do

Review and confirm the accuracy of patient insurance information within the system.
Verify benefits via insurance portals or phone to confirm coverage for treatments, procedures, and specialist visits.
Determine financial responsibility (deductibles, copays, coinsurance) and communicate these details to patients and providers.
Identify when a referral is required and coordinate with Primary Care Physicians (PCP) to obtain it.
Review medical records to confirm medical necessity and compliance with policy guidelines.
Collect and prepare required documentation, including clinical notes, imaging, and CPT/ICD-10 codes.
Submit and track prior authorization requests to ensure timely approvals and upload letters to patient charts.
Coordinate Peer-to-Peer (P2P) reviews and initiate appeals for denied services by gathering missing documentation.
Keep patients informed regarding insurance coverage, out-of-pocket costs, and authorization outcomes.
Communicate payer decisions promptly to providers, staff, and office managers.
Monitor daily schedules for add-ons or cancellations that may affect authorizations.
Maintain strict adherence to HIPAA compliance standards and specific payer guidelines.

What You’ll Bring to the Team

2+ years of experience in medical insurance verification, benefits eligibility, and prior authorizations.
Strong knowledge of insurance terminology, CPT, and ICD-10 coding.
Experience managing referral databases and verifying in-network coverage.
Experience with claims follow-up and resolving authorization denials.
Familiarity with EHR/EMR platforms (e.g., eClinicalWorks, Epic) and insurance portals (e.g., Availity, ClaimMD).
Strong professional English skills (written and spoken) to navigate US-based insurance communications.
Meticulous attention to detail with a process-driven approach to documentation.
Exceptional interpersonal skills; empathetic with patients and professional with providers and payers.
Ability to manage multiple priorities and high-volume workloads in an on-site environment.

What We Offer

Competitive compensation aligned with experience and expertise.
Structured, compliance-focused healthcare environment.
Close collaboration with clinical, administrative, and billing teams.
Direct impact on patient access to care and revenue cycle efficiency.
Growth opportunities within medical policy and healthcare operations.