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Health insurance agent vs insurance verification specialist

The differences between health insurance agents and insurance verification specialists can be seen in a few details. Each job has different responsibilities and duties. Additionally, a health insurance agent has an average salary of $49,934, which is higher than the $33,043 average annual salary of an insurance verification specialist.

The top three skills for a health insurance agent include HIPAA, health insurance and customer service. The most important skills for an insurance verification specialist are patients, insurance verification, and customer service.

Health insurance agent vs insurance verification specialist overview

Health Insurance AgentInsurance Verification Specialist
Yearly salary$49,934$33,043
Hourly rate$24.01$15.89
Growth rate6%6%
Number of jobs112,23571,688
Job satisfaction--
Most common degreeBachelor's Degree, 50%Associate Degree, 27%
Average age4646
Years of experience--

What does a health insurance agent do?

Health Insurance Agents are salespeople whose primary product is health insurance. Insurance companies hire them to reach sales targets. They are trained to sell insurance to individuals or groups of people. They are expected to be familiar with all the products of the company. Health Insurance Agents should assess their clients' needs and recommend the best health insurance product that fits their needs. They should be able to explain the product's features and answer any inquiries that the clients may have. Health Insurance Agents should also know how to compute insurance premiums and estimate payouts.

What does an insurance verification specialist do?

An insurance verification specialist is responsible for confirming a patient's insurance details and eligibility to receive medical care services. Insurance verification specialists review the insurance documents of the patients, including its coverage and limitations, and escalate concerns to the supervisor for immediate resolution. They process paperwork accordingly upon coordinating with the patients and attending health professionals. An insurance verification specialist must have excellent communication and organizational skills, finishing administrative tasks efficiently under minimal supervision.

Health insurance agent vs insurance verification specialist salary

Health insurance agents and insurance verification specialists have different pay scales, as shown below.

Health Insurance AgentInsurance Verification Specialist
Average salary$49,934$33,043
Salary rangeBetween $34,000 And $72,000Between $28,000 And $37,000
Highest paying CityTacoma, WAMadison, WI
Highest paying stateAlaskaNew Hampshire
Best paying companyDialAmericaSt. Luke's Cataract & Laser Institute
Best paying industryFinancePharmaceutical

Differences between health insurance agent and insurance verification specialist education

There are a few differences between a health insurance agent and an insurance verification specialist in terms of educational background:

Health Insurance AgentInsurance Verification Specialist
Most common degreeBachelor's Degree, 50%Associate Degree, 27%
Most common majorBusinessHealth Care Administration
Most common collegeUniversity of PennsylvaniaUniversity of Pennsylvania

Health insurance agent vs insurance verification specialist demographics

Here are the differences between health insurance agents' and insurance verification specialists' demographics:

Health Insurance AgentInsurance Verification Specialist
Average age4646
Gender ratioMale, 43.5% Female, 56.5%Male, 11.4% Female, 88.6%
Race ratioBlack or African American, 9.2% Unknown, 3.6% Hispanic or Latino, 15.8% Asian, 4.9% White, 66.5% American Indian and Alaska Native, 0.1%Black or African American, 9.3% Unknown, 3.6% Hispanic or Latino, 16.0% Asian, 4.9% White, 66.1% American Indian and Alaska Native, 0.1%
LGBT Percentage7%7%

Differences between health insurance agent and insurance verification specialist duties and responsibilities

Health insurance agent example responsibilities.

  • Manage communication points between corporate advisers, providers and patients for medical service advisory requests.
  • Sold/Enrol individuals in ACA health plans over the phone by making cold calls on a daily basses.
  • Explain healthcare benefits cover by major insurance carriers under the ACA.
  • Post CPT codes and ICD-9 codes for every patient at check-out.
  • Verify clients' eligibility and check clients' status within CMS and UHC system.
  • Initiate appeals process on behalf of members, and assist with online web portal services.
  • Show more

Insurance verification specialist example responsibilities.

  • Check CPT and ICD-10 codes with LCD and policies from multiple insurance companies to make sure procedures will be paid.
  • Support the patient privacy/confidentiality policies and regulations under HIPAA for patients and their medical records.
  • Confirm correct charges base on HCPCS codes.
  • Assist callers as well with questions about their benefits, terms and conditions of medical plans, appeals and grievances.
  • Provide medical record support in the absence of EMR: assist clinics and hospitals in obtaining medical records in appropriate format.
  • Document outbound communication from providers and veterans.
  • Show more

Health insurance agent vs insurance verification specialist skills

Common health insurance agent skills
  • HIPAA, 57%
  • Health Insurance, 11%
  • Customer Service, 8%
  • Health Insurance Products, 3%
  • Health Insurance Sales, 2%
  • Inbound Calls, 2%
Common insurance verification specialist skills
  • Patients, 25%
  • Insurance Verification, 15%
  • Customer Service, 7%
  • Insurance Eligibility, 5%
  • Data Entry, 4%
  • Medical Terminology, 4%