What does a Health Insurance Specialist do?

Health insurance specialists provide expertise about health insurance programs, regulations, procedures, and legislative updates. They are commonly employed by medical practitioner groups, healthcare facilities, or government agencies. They analyze and process contracts and other documents, develop compliance and audit procedures, and prepare reports and other materials. They monitor critical policy changes and confirm any necessary adjustments are implemented to ensure compliance. They may also perform tasks related to coverage verification and obtaining prior authorizations.

Health insurance specialists typically have a bachelor’s degree in a business field, but significant professional experience related to health insurance may be acceptable as a substitute. They must have extensive knowledge of regulations and procedures related to private insurance and government programs such as Medicaid and Medicare. These roles require good computer skills and proficiency with common office software programs.

What responsibilities are common for Health Insurance Specialist jobs?
  • Processes credit card payments and posts payment to the appropriate account.
  • Other duties and projects will be assigned as needed.
  • Answer telephone billing inquiries from customers, outside sources and in-house personnel.
  • Perform various follow up activities including telephone calls, appeals, letters and utilizes payer websites to achieve timely resolution.
  • Partner with the appropriate staff and departments to ensure optimal working relationships.
  • Prepare refund requests or forward to appropriate person depending on department/area.
  • Review accounts to be considered for write off due to exhausted follow up efforts and time limits.
  • Review accounts with balances that were a result of incorrect payer payments/adjustments.
  • Ensure compliance with quality assurance and productivity department goals specific to main job responsibilities for each area of the business office.
  • Maintain skill proficiency, including improvement where deemed necessary, and upgrading any additional or new skills on the appropriate position skills list.
  • Assist customers to make health care decisions by carefully matching customers with the optimal products and services.
What are the typical qualifications for Health Insurance Specialist jobs?
  • Bachelor's or Graduate's Degree in business, business administration, computer science, engineering or management.
  • Sound leadership and problem solving capabilities.
  • Proven record of attention to detail, time management, and multitasking skills.
  • Fluent in insurance process, including negotiation, reserving, and liabilities.
  • Fluency in a variety of programs, software, and systems such as C#, GS-13, MVC, and R Language.
  • Experienced in delegated examining.
  • Fluent in working with clients to select proper plans and arranging for signups.
Education--
Work/Life Balance
3.3 ★
Total Pay--
Career Opportunity
3.3 ★
Avg. Experience0-1 year

How much does a Health Insurance Specialist make?

Confident
$62,691 /yr
Total Pay
$49,027
 /yr

Base Pay

+
$13,665
 /yr

Additional Pay

$62,691

 / yr
$31K$215K
Most Likely Range
Possible Range
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Health Insurance Specialist Career Path

Learn how to become a Health Insurance Specialist, what skills and education you need to succeed, and what level of pay to expect at each step on your career path.

Average Years of Experience

0 - 1
38%
2 - 4
33%
5 - 7
0%
8+
29%
Not including years spent in education and/or training
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Health Insurance Specialist Insights

Read what Health Insurance Specialist professionals have to say about their job experiences and view top companies for this career.
SelectQuoteSelectQuote
Licensed Medicare Agent
Nov 12, 2021

“Your commission is based on a sliding a sliding scale based on your performance as staked up against your peers.”

eHealtheHealth
Licensed Medicare Agent
Dec 7, 2020

“The job is solid and the pay is great.”

eAssisteAssist
Insurance Verification Consultant
Jan 19, 2022

“It’s very flexible and I create my own schedule.”

SelectQuoteSelectQuote
Licensed Medicare Agent
Aug 25, 2021

“This wasn't discussed when hired so ultimately was the only reason this job wasn't a suitable fit for me and my expectations.”

US Health GroupUS Health Group
Licensed Medicare Agent
Apr 1, 2022

“base pay is not the best”

Western Dakota InsurorsWestern Dakota Insurors
Licensed Life and Health Insurance Agent
Nov 10, 2020

“Great employees to work with”

Centers for Medicare & Medicaid ServicesCenters for Medicare & Medicaid Services
Health Insurance Specialist
Feb 8, 2022

“great work life balance”

Texas Digestive Disease ConsultantsTexas Digestive Disease Consultants
Insurance Verification
Jul 29, 2020

“Work morale is terrible.”

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Health Insurance Specialist Interviews

Frequently asked questions about the roles and responsibilities of a Health Insurance Specialist

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Health Insurance Specialist Jobs