Gestionnaire de la vérification des assurances et des prestations

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.