Insurance Eligibility Verification Agent

Coverage problems found at check-in lead to denied claims or awkward conversations at the front desk. Two days before appointments, this agent checks each patient's insurance with the payer, confirming the plan, copay, deductible status and network. It also checks whether the service needs prior authorization. When coverage is inactive or details have changed, it flags the patient and drafts a message asking for updated insurance. Out-of-network results go to the front desk. After the patient updates, it reruns the check until coverage is confirmed or the issue is handed off. Services needing authorization go to the authorization team. The biller approves every patient message and any rescheduling. Edge case: a patient's plan changed on the first of the month, so the agent finds the new payer in the eligibility response instead of reporting coverage as lost.