L4 – Team Lead – Eligibility & Benefits Specialist – THE GATEKEEPER

Wonderworth Solutions

The Role :

Before a claim is created, patient insurance must be verified—and that starts with you.
You are the first checkpoint in the revenue cycle, where accuracy drives downstream success.
In the Day Shift, you use portals and APIs to verify coverage at scale with precision.
No assumptions—every chart is validated before moving forward.

What You Will Own – Your Responsibilities :

Portal & API-based eligibility verification — validating demographics, insurance status, network participation, and date-of-service requirements
Chart classification — marking charts as Approved, Held, or Denied based on verification outcomes
Historical data review — analyzing prior coverage and identifying discrepancies before escalation
Assignment coordination — handing off unresolved or complex cases to Night Shift with complete documentation

Non-Negotiable Metric :

FIRST-PASS VERIFICATION ACCURACY · TARGET: 98%
Percentage of charts verified correctly without requiring rework or escalation.

The Fight: What You will Fight:

The incomplete submission. A file that looks ready — until it gets denied.
You fight the assumption that “this is enough” — the missing document that was overlooked, the HCPCS code that wasn’t fully validated, the checklist that was not followed end-to-end.
On the Day Shift — nothing is sent forward unless it is complete, accurate, and submission-ready.

WHO THRIVES HERE :

You verify — you do not assume — Every chart is checked, every time, without exception
You work with structured precision — You follow process, document outcomes, and maintain consistency at scale
You think ahead — You identify issues early and ensure Night Shift receives complete, actionable cases

THE WWS PERKS :

Qualifications:

Experience: 3+ years of experience in Eligibility & Benefits verification, healthcare operations, or insurance support roles with Team Lead/L4 handling experience
Education: Bachelor’s degree in any discipline
Knowledge: Basic understanding of healthcare insurance processes, eligibility verification workflows, payer portals, and API-based verification preferred
Attention to Detail: High accuracy in eligibility validation, insurance verification, and documentation review
Leadership Skills: Experience in handling teams, monitoring productivity, managing escalations, and ensuring process adherence
Communication: Strong coordination, documentation, and stakeholder communication skills across Day Shift and Night Shift operations
Analytical Skills: Ability to identify discrepancies, resolve verification issues, and ensure first-pass accuracy consistently