Insurance Verification & Benefit Manager

Official role description

Mercor is working with a leading AI research lab to improve the capabilities of next-generation AI systems. We are seeking experienced Insurance Verification and Eligibility & Benefits Managers to evaluate AI tools designed to automate front-end revenue cycle operations. Your deep expertise in payer systems, EDI transactions, and eligibility workflows will directly inform AI models that drive accuracy and efficiency in insurance verification processes.

Responsibilities • Oversee insurance verification, eligibility determination, and benefits investigation workflows across commercial, Medicare, Medicaid, and managed care payers. • Verify patient insurance coverage using payer portals, clearinghouses, and EDI 270/271 real-time eligibility transactions. • Identify and resolve coordination of benefits issues, coverage gaps, and eligibility discrepancies prior to service delivery. • Evaluate and annotate AI-generated eligibility verification outputs for accuracy, completeness, and payer compliance. • Develop and document SOPs for eligibility and benefits verification workflows. • Monitor KPIs including verification accuracy rates, front-end denial rates related to eligibility, and turnaround times. • Ensure compliance with payer-specific requirements, CMS guidelines, and HIPAA regulations. • Identify process gaps and recommend workflow improvements to reduce eligibility-related claim denials. • Provide structured feedback and annotations to support AI training datasets.

Requirements • 5+ years of experience in insurance verification, eligibility and benefits management, or front-end revenue cycle operations, with at least 2 years in a management role. • Expert knowledge of EDI 270/271 transactions, payer portal navigation, and real-time eligibility tools. • Strong familiarity with Medicare, Medicaid, and commercial payer eligibility requirements and benefit structures. • Proficiency with Epic, Cerner, Meditech, or equivalent EHR platforms. • Experience with clearinghouse platforms such as Availity, Change Healthcare, or similar. • Exceptional written and verbal English communication skills. • High attention to detail with the ability to identify subtle discrepancies in coverage data.

Preferred Qualifications • CHAM, CHAA, or equivalent front-end revenue cycle certification. • Experience with automated eligibility verification tools and RPA solutions. • Background in denial root cause analysis related to eligibility and coverage errors. • Familiarity with AI tools and comfort evaluating AI-generated healthcare content. • Experience presenting eligibility performance data to senior leadership.

Why Join? • Contribute to the development of frontier AI systems in healthcare. • Collaborate with a world-class AI research organisation. • Gain exposure to cutting-edge AI workflows in healthcare revenue cycle management. • Opportunity to work on high-impact projects shaping the future of healthcare AI.