Insurance Analyst

Title: Insurance Analyst

Location: New York City United States

Job Description:

Job Title: Insurance Analyst

Classification: 1099

Work Structure: Fully Remote

Shift: Monday-Friday, Day Shift (EST), 40 hours/week

Team: Enrollment Operations

Reports to: Product Manager

Location: United States (EST or CST Preferred)

Compensation: $25-$28 per hour

About Us

We are a mission-driven organization of clinicians, engineers, and professionals dedicated to transforming cardiovascular health. Our focus is on reducing the impact of heart disease through innovative solutions. Leveraging evidence-based research and telemedicine, we deliver specialized exercise and wellness programs tailored to older adults. Our goal is to enhance patients' lives by promoting heart health and offering exceptional care that makes a lasting impact.

Job Summary

We are expanding rapidly and are looking for a dynamic, self-starter to lead our insurance function as we scale to new partners and markets. The Insurance Analyst is a dual-role position that blends hands-on insurance verification expertise with high-level data analysis and strategic process improvement. This role is perfect for someone who has a strong background in U.S. insurance verification processes, is highly analytical and thrives in a fast-paced startup environment.

Key Responsibilities

Insurance Analytics

• Aggregate & analyze data to identify areas for improvement in insurance verification process
• Work with internal teams including product & engineering to build & optimize features in proprietary CRM
• Produce clear documentation to align teams and communicate complex workflows effectively.
• Own & manage vendor relationships for manual insurance checks. Lead new implementations and ensure seamless expansion as we onboard new partners.

Insurance Verification and Authorization

• Handle escalations and communicate with patients regarding co-pays, coverage, benefits, and care authorizations.
• Review and validate patient insurance information, ensuring accuracy in billing and demographic details. Determine member benefit coverage for treatments and procedures.
• Build process to submit prior authorizations from insurance companies.

Team Leadership and Development

• Hire a team of insurance verification specialists, providing coaching and performance feedback to ensure high standards of insurance verification quality and accuracy.
• Manage training for team roles, maintaining alignment with operational goals and KPIs.

Patient Coordination and Communication

• Communicate with patients regarding co-pays, coverage, benefits, and care authorizations.
• Support cross-functional collaboration by sharing insurance authorization and appeals processes with providers and assisting the scheduling team.
• Analyze and optimize outreach methods to improve patient engagement, collaborating with Product & Engineering teams to refine technical workflows.
• Develop best practices and evaluate key performance indicators (KPIs) for the insurance verification process.

Qualifications

• Experience:
• 3-5 years of direct experience in insurance verification within a hospital, outpatient facility, or physician practice setting.
• Experience screening, hiring, and managing teams of 2+, with a track record of meeting KPIs.
• Proven experience in analyzing large data sets to drive strategic decisions.
• Experience managing third-party vendors or partners.
• Skills:
• Strong knowledge of healthcare topics, including insurance products, ICD-10 billing, CPT codes, and EHR systems.
• Strong understanding of prior authorization processes.
• Proficiency in online insurance portals such as Navinet, Availity, etc.
• Advanced proficiency in Excel/Google Docs.
• Experience with SQL is a plus.
• Effective communication skills, with experience using Slack/Teams for team collaboration.
• Preferred:
• Start-up experience or demonstrated ability to thrive in a fast-paced, evolving environment.

Personality & Cultural Fit

• Self-Starter: Highly motivated and proactive, able to take initiative without requiring constant direction.
• Analytical Thinker: Capable of strategic problem-solving using data-driven insights.
• Adaptable & Agile: Thrives in a dynamic, fast-paced environment and can adjust quickly to new challenges.
• Growth-Oriented: Excited to grow into an integral role within our company and contribute to our long-term vision.

Additional Information

This role requires adherence to HIPAA and company confidentiality guidelines. All employees must pass a background check.

This description provides an overview of the Insurance Verification Manager's responsibilities and qualifications. As the company grows, job requirements may evolve to meet changing needs.

• Note: This is a 1099 contractor position