Insurance Verification Operations Lead

Job Title: Insurance Verification Operations Lead (1099)

Classification: Full Time/1099 Contractor

Work Structure: Fully Remote

Schedule/Shift: Monday-Friday; 7:30am-8:30am ET OR 8a-4p ET

Team: Clinical Operations

Location: United States

Compensation: $35 per hour

Overview

We are seeking a highly experienced Insurance Verification Operations Lead to own and continuously improve the performance of our insurance verification function. This individual will be accountable for ensuring verifications are completed accurately, efficiently, and in a way that minimizes downstream denials, while operating effectively in a fast-paced, evolving startup environment. This is a hands-on, execution-oriented role with significant autonomy and responsibility.

 

Core Responsibilities

• Own the day-to-day execution of insurance verification operations, ensuring verifications are completed within required SLAs and prioritized appropriately based on payor behavior, plan complexity, and business urgency.

• Provide functional oversight and guidance to the insurance verification team, ensuring consistent performance, clear prioritization, and adherence to best practices.

• Serve as a subject-matter expert for insurance denials, partnering with external partners to investigate, resolve, and prevent denials related to eligibility, benefits, and authorization errors.

• Perform ongoing quality assurance on verification calls and records, identifying trends, gaps, and training opportunities to continuously improve outcomes.

• Handle complex patient escalations related to insurance coverage, benefits, cost-sharing, and authorization requirements, including direct patient outreach when needed.

• Translate payor-specific nuances, denial patterns, and verification learnings into clear operational guidance for the team.

• Partner closely with cross-functional stakeholders (operations, partnerships, product) to ensure verification processes scale effectively as volume and complexity increase.

 

Required Experience and Qualifications

• 10+ years of experience in insurance verification, prior authorization, and/or revenue cycle management, with deep familiarity across Medicare and Medicare Advantage payors.

• Demonstrated experience overseeing insurance verification functions or teams, including performance monitoring, QA, and process improvement.

• Exceptional technical proficiency, including advanced Excel skills; candidates should expect to complete an Excel-based assessment.

• Deep understanding of payor behavior, denial drivers, and verification best practices, with the ability to apply that knowledge in real-time operational decision-making.

• Comfort working in a startup environment where processes are evolving and ownership is critical.

*Note: This is a 1099 contractor position