Wound Care Insurance Verification Specialist

6 days ago

South Africa NIVA Health Full time R15 678 per year

Wound Care Insurance Verification Specialist (Remote)

Do you have a meticulous eye for detail and a passion for helping patients access the care they need? Are you experienced in navigating insurance guidelines, prior authorizations, and the specialized world of wound care? If so, NIVA Health invites you to apply for our Remote Insurance Verification Specialist position

At NIVA Health, our mission is simple: helping people heal. Every day, our nationwide team stands shoulder to shoulder, delivering compassionate, expert care to patients who deserve to live healthier, fuller lives. As a key member of our authorization coordination team, you will play a pivotal role in ensuring patients receive timely, necessary treatment, all while exemplifying our Core Values of Teamwork, Resilience, Open-Mindedness, Ownership, and Positivity.

In This Role, You'll:

  • Submit and manage prior authorization requests for wound care treatments, ensuring that all documentation meets payer requirements.
  • Handle PCP referrals/authorizations and follow up to facilitate smooth patient care.
  • Prepare and track Single Case Agreements/GAP exceptions for out-of-network cases.
  • Communicate with insurance providers to clarify coverage, resolve denials, and facilitate appeals.
  • Maintain precise records of authorizations, denials, appeals, and corresponding documentation.
  • Stay up to date with insurance policies, coding changes, and criteria for wound care procedures.
  • Collaborate with healthcare providers, nurses, and admin staff to gather complete, accurate documentation for submissions.
  • Serve as a patient advocate, keeping patients informed about the status of their authorizations and potential out-of-pocket expenses.
  • Conduct your work with utmost discretion, diplomacy, and tact during all patient and staff interactions.
  • Contribute to other duties of similar complexity as assigned by your supervisor.

You're a Great Fit If You:

  • Possess at least 1 year of experience in prior authorization management, specifically within wound care services.
  • Demonstrate a strong work ethic, self-motivation, and a "can-do" attitude.
  • Communicate clearly, empathetically, and professionally with patients, staff, and payers.
  • Understand the intricacies of insurance processes, medical terminology, and healthcare systems.
  • Are proficient with electronic medical records (EMR) and case management software.
  • Excel at collaborating with multidisciplinary healthcare teams and solving complex problems.
  • Embody NIVA Health's Core Values in every interaction with patients and colleagues.

Bonus Points If You:

  • Are experienced in handling appeals, denials, and single case agreements.
  • Bring innovative approaches to patient advocacy and insurance coordination.
  • Stay informed about industry trends, especially in advanced wound care and insurance policy changes.

Why Join Us?

At NIVA Health, your efforts are instrumental in ensuring that patients receive the life-changing care they deserve. We celebrate our team's achievements, invest in personal and professional growth, and provide meaningful work in a values-driven, supportive environment. Join us and help shape a brighter, healthier future for all—one successful authorization at a time

Pay: $1,300 per month

Work Schedule: US Timezone (East Coast)

Job Type: Full-time

Work Location: Remote

Job Type: Full-time

Pay: Up to R22 630,28 per month

Application Question(s):

  • What is your salary expectation per month (USD)?

Experience:

  • Medical Insurance: 1 year (Required)
  • US-based Medical Insurance: 1 year (Required)

Work Location: Remote

  • Nursing Verification

    4 days ago

    South Africa ISTA Personnel Solutions Full time R250 000 - R400 000 per year

    ISTA Personnel Solutions South Africa – We are a global Business Process Outsourcing (BPO) company partnering with a USA-based client that provides skilled nursing care to homebound paediatric patients. We are currently seeking a Nursing Verification & Support Coordinator to join their dynamic and growing team.The purpose of this role is to ensure that...

  • Patient Intake Specialist

    4 days ago

    South Africa ISTA Personnel Solutions Full time R250 000 - R450 000 per year

    ISTA Personnel Solutions South Africa - we are a global BPO company, partnering with a USA-based client in the Healthcare sector. We are seeking a Patient intake Specialist to join our remote support team. The ideal candidate is detail-oriented, organized, and comfortable working in a high-volume, fast-paced environment. This dual-role position focuses on...

  • Skin Care

    2 weeks ago

    Cape Town, South Africa MF Spa & Beauty Placements Full time R11 000 - R13 000

    SKIN CARE & FACIAL SPECIALIST CAPE TOWN CENTRAL BUSINESS DISTRICT - City of Cape Town, Western Cape (ZA) START: 01 January 2026 TRADING HOURS & SHIFTS Monday – Friday 08:00 - 17:00 Saturdays by appointment only - additional Monday off in lieu of working a Saturday Sundays & Major Public Holidays - CLOSED REPORT TO: Salon Manager  EMPLOYMENT TERMS: Full...

  • Insurance Officer

    1 week ago

    South Africa World Bank Group Full time R40 000 - R120 000 per year

    Insurance Officer - Investment and Credit Risk Job #: req34987Organization: IFCSector: RiskGrade: GFTerm Duration: 3 years 0 monthsRecruitment Type: Local RecruitmentLocation: Johannesburg,South AfricaRequired Language(s): EnglishPreferred Language(s): FrenchClosing Date: 12/2/2025 (MM/DD/YYYY) at 11:59pm UTCDescriptionBuild a career with impact....

  • Customer Care Specialist

    1 week ago

    South Africa - Remote Illumina Full time R250 000 - R500 000 per year

    What if the work you did every day could impact the lives of people you know? Or all of humanity?At Illumina, we are expanding access to genomic technology to realize health equity for billions of people around the world. Our efforts enable life-changing discoveries that are transforming human health through the early detection and diagnosis of diseases and...

  • Client Care Coordinator

    4 days ago

    South Africa ISTA Personnel Solutions Full time R250 000 - R500 000 per year

    ISTA Personnel Solutions South Africa is a dynamic and fast-growing BPO company based in South Africa, specializing in providing top-tier operational support to U.S.-based companies. We are not a recruitment agency—we are a dedicated extension of our clients' teams, delivering high-quality service with precision, efficiency, and a personal touch.We are...

  • B-bbee Specialist Sustainability

    2 weeks ago

    South Africa Mr Price Group Full time

    **B-BBEE Specialist** **purpose** The Mr Price Sustainability Department is seeking a highly organized, disciplined, self-motivated and confident individual with a thorough knowledge of B-BBEE for a permanent B-BBBEE Specialist role. Accountable for enabling Group B-BBEE compliance in terms of the relevant legislation, regulations and codes, you will guide...

  • Short Term Insurance Commercial Claims Administrator

    2 weeks ago

    South Africa Insure Connect Services Full time R280 000 - R420 000 per year

    Short-Term Insurance Claims Administrator (Remote / Hybrid – South Africa)Company: Insure Connect ServicesLocation: Cape Town (Remote or Hybrid)Job Type: Full-timeSalary: R25 000 – R33 000 per month (depending on experience)About UsAt Insure Connect Services, we deliver specialist claims and underwriting support to international insurance brokers and...

  • Short Term Insurance Specialist

    1 day ago

    Nelspruit, South Africa 3RC (Pty) Ltd Full time R10 000 - R15 000

    As a Short-Term Insurance Broker, you will be responsible for providing expert advice and guidance to clients on their short-term insurance needs. You will build and maintain relationships with clients, identify new business opportunities, and work closely with our underwriting team to ensure seamless policy issuance.

  • Enrolled Nurse

    1 day ago

    Kempton Park, South Africa Medical Resources Group (Pty) Ltd Full time R15 000 - R17 000

    Job Title: Enrolled Nurse Location: Kempton Park About the Role Our client, a reputable and well-established General Practice based in Kempton Park, is seeking a dedicated Enrolled Nurse registered with SANC to join their team. The ideal candidate will perform basic nursing duties and health assessments in line with professional standards and scope of...