Job Description

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 seeking a detail-oriented and proactive Medical Licencing Verifications Specialist for our U.S.-based client, a growing multi-state provider of Applied Behaviour Analysis (ABA) therapy services for children with autism. This role sits at the intersection of compliance and negotiation: You'll manage the credentialing (medical licencing verfications) of newly hired clinicians/therapists with insurance providers, and drive the research and outreach needed to get the company in-network with new insurers as they expand into new states.

PLEASE NOTE:

• Working Hours: Monday to Friday, 15:00 PM – 00:00 AM South African time – subject to changes due to daylight saving.
• Public Holidays: This role requires you to work on both South African and US public holidays (compensation for SA public holidays in accordance with the BCEA).
• Internet Requirements: A fixed fibre line with a minimum speed of 25 Mbps (upload & download), capable of supporting a wired Ethernet connection, is mandatory. LTE, satellite internet (e.g. Starlink), Rain wireless/mobile broadband, and mobile hotspots will not be considered.
• Power Backup: A reliable power backup solution - solar, an inverter, or a UPS - capable of sustaining your internet and workstation through load shedding and power outages is required. Applicants without one cannot be considered.
• Work Environment: This is a fully remote working role.

Key Responsibilities:

• Manage insurance credentialing and medical licencing verifications for newly hired clinicians, updating documentation and portal profiles with individual insurers to ensure compliance and correct billing
• Research insurance landscapes in new states as the company expands, identifying which insurers to prioritize for network participation
• Reach out to insurance companies to understand credentialing requirements, application processes, and reimbursement rate structures
• Negotiate reimbursement rates with insurers where offered rates fall below competitive benchmarks
• Track credentialing and contracting progress, flagging delays or issues proactively
• Maintain accurate, audit-ready records across multiple insurer portals and systems
• Follow established workflows and escalate matters appropriately when required
• Complete other ad hoc coordination tasks as needed

Requirements

• U.S. health insurance experience, including private insurers and Medicaid
• Excellent communication skills and strong English fluency (verbal and written)
• Strong critical thinking and independent problem-solving skills, particularly for the contracting/negotiation side of the role
• A confident, proactive attitude - comfortable initiating contact with insurers and pushing for better terms
• Detail-oriented and highly organized, with the discipline to manage multiple portals and deadlines accurately
• Basic computer literacy, including MS Office and Outlook (no advanced Excel skills required)
• Experience with ABA-specific insurance processes is a strong plus, but not required
• Ability to work independently with minimal day-to-day supervision

If you are not contacted within 14 working days, please consider your application unsuccessful.