Health insurance specialist job description
Updated March 14, 2024
5 min read
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Example health insurance specialist requirements on a job description
Health insurance specialist requirements can be divided into technical requirements and required soft skills. The lists below show the most common requirements included in health insurance specialist job postings.
Sample health insurance specialist requirements
- Bachelor's degree in Health Administration or related field.
- Minimum of 2 years of experience in the health insurance industry.
- Familiarity with healthcare regulations and laws.
- Knowledge of health insurance software systems.
- Proficiency in MS Office Suite.
Sample required health insurance specialist soft skills
- Strong customer service and communication skills.
- Ability to work both independently and in a team environment.
- Highly organized and detail-oriented.
- Demonstrated problem-solving skills.
- Ability to handle multiple tasks simultaneously.
Health insurance specialist job description example 1
Great River Health health insurance specialist job description
Coordinates and assists in reimbursement for services provided. Accurately files insurance claims for the purpose of settling claims with insurance carrier.
Handles all electronic billing functions. Verifies accuracy of billing data and revises any errors. Operates typing, adding, calculating, and billing software. Prepares itemized statements, bills, or invoices; and records amounts due for services rendered. Performs data entry work, including posting charges and keeping other records concerning patient charges. Keeps records of supporting documents. Resolves discrepancies in accounting records. Types billing documents, processes credits using computers. Contacts patients in order to obtain or relay account information. Computes rates for services in order to complete billing documents. Electronic claim filing. Maintains electronic filing system. Process new insurance policies, modifications to existing policies, and claims forms. Obtain information from policyholders to verify the accuracy and completeness of information on claims forms, applications and related documents, and company records. Update existing policies and company records to reflect changes requested by policyholders and insurance company representatives. Maintains knowledge of current government and/or carrier regulations relevant to industry. Follows-up on outstanding accounts and makes proper notations in billing software. Work denials and appeals for all insurance carriers. Reviews information for follow-up on primary and secondary insurances to file, re-file, or appeal claims. Resolves billing issues by correctly answering questions, determining & recommending how outstanding accounts should be further processed, and providing appropriate follow-up on issues.
Qualifications:
High School diploma
Medical terminology preferred
Prior Home Health and/or Hospice billing experience preferred.
Customer service experience required
Experience working with computers
Typing experience, 45 WPM
Benefits:
We are excited to offer an aggressive compensation and benefits package for qualifying positions, which includes:
+ Competitive base pay
+ Matching 401(k) and 403(b) retirement programs, with on-site personal investment counseling
+ Health, Dental and Vision plans
+ Health Savings and Flexible Spending Accounts
+ Employee discounts including car rental, cell-phone plans
+ Employer-paid, Long- term disability
+ Employer-paid, Life and AD&D
+ Paid time off (PTO)
+ Tuition reimbursement
+ Employee Assistance Program
+ Employee Referral Bonus Program
+ Discounted cafeteria meals
+ Free employee gym membership
+ Employee Service Recognition program
+ Voluntary plans including: Life, AD&D, Critical Illness, Accident and Pet insurance
COVID-19 Mandate
As a healthcare employer, Great River Health is adhering to CMS regulation requiring COVID-19 vaccination for health care workers.
As such, we are requiring all new hires and employees to show proof of being fully vaccinated for COVID-19 or receive an approved accommodation by their date of hire, as a condition of employment.
As we continue to navigate the ever-changing COVID-19 pandemic, we remain committed to doing our part to ensure the health, safety, and well-being of our team members and our communities. Proof of vaccination or accommodations requests will be collected once an offer is accepted with Great River Health. All accommodation requests will be carefully considered but are not guaranteed to be approved.
Great River Health and its affiliates are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.
Handles all electronic billing functions. Verifies accuracy of billing data and revises any errors. Operates typing, adding, calculating, and billing software. Prepares itemized statements, bills, or invoices; and records amounts due for services rendered. Performs data entry work, including posting charges and keeping other records concerning patient charges. Keeps records of supporting documents. Resolves discrepancies in accounting records. Types billing documents, processes credits using computers. Contacts patients in order to obtain or relay account information. Computes rates for services in order to complete billing documents. Electronic claim filing. Maintains electronic filing system. Process new insurance policies, modifications to existing policies, and claims forms. Obtain information from policyholders to verify the accuracy and completeness of information on claims forms, applications and related documents, and company records. Update existing policies and company records to reflect changes requested by policyholders and insurance company representatives. Maintains knowledge of current government and/or carrier regulations relevant to industry. Follows-up on outstanding accounts and makes proper notations in billing software. Work denials and appeals for all insurance carriers. Reviews information for follow-up on primary and secondary insurances to file, re-file, or appeal claims. Resolves billing issues by correctly answering questions, determining & recommending how outstanding accounts should be further processed, and providing appropriate follow-up on issues.
Qualifications:
High School diploma
Medical terminology preferred
Prior Home Health and/or Hospice billing experience preferred.
Customer service experience required
Experience working with computers
Typing experience, 45 WPM
Benefits:
We are excited to offer an aggressive compensation and benefits package for qualifying positions, which includes:
+ Competitive base pay
+ Matching 401(k) and 403(b) retirement programs, with on-site personal investment counseling
+ Health, Dental and Vision plans
+ Health Savings and Flexible Spending Accounts
+ Employee discounts including car rental, cell-phone plans
+ Employer-paid, Long- term disability
+ Employer-paid, Life and AD&D
+ Paid time off (PTO)
+ Tuition reimbursement
+ Employee Assistance Program
+ Employee Referral Bonus Program
+ Discounted cafeteria meals
+ Free employee gym membership
+ Employee Service Recognition program
+ Voluntary plans including: Life, AD&D, Critical Illness, Accident and Pet insurance
COVID-19 Mandate
As a healthcare employer, Great River Health is adhering to CMS regulation requiring COVID-19 vaccination for health care workers.
As such, we are requiring all new hires and employees to show proof of being fully vaccinated for COVID-19 or receive an approved accommodation by their date of hire, as a condition of employment.
As we continue to navigate the ever-changing COVID-19 pandemic, we remain committed to doing our part to ensure the health, safety, and well-being of our team members and our communities. Proof of vaccination or accommodations requests will be collected once an offer is accepted with Great River Health. All accommodation requests will be carefully considered but are not guaranteed to be approved.
Great River Health and its affiliates are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.
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Health insurance specialist job description example 2
UCLA health insurance specialist job description
Responsibilities
Venice Family Clinic is a
leader in providing comprehensive, high-quality primary health care to people
in need with compassion, dignity and respect. In November 2021, Venice Family
Clinic merged with South Bay Family Health Care, uniting more than a century of
experience helping patients regardless of their income, insurance or
immigration status. The organization now has more than 500 staff who serve
45,000 people from the Santa Monica Mountains through the South Bay. We have 17
locations plus two mobile clinics and an expansive street medicine program for
people experiencing homelessness. Read more about us at venicefamilyclinic.org.
Under the direct supervision
of the Health Insurance Program Manager, the Senior Health Insurance (HIE)
Specialist will provide high quality screening/enrollment to patients and
provide advocacy accessing and utilizing services. The Senior HIE Specialist
will be able to properly determine the degree of case urgency and create an
appropriate resolution plan. The Senior HIE Specialist should be knowledgeable
of current Public Health Insurance and other public benefit programs (e.g. Cal Fresh/SNAP)
in order to respond to clients and outside agencies regarding Medi-cal, Covered
CA, My Health LA, Cal Fresh and other health access concerns. They will be able
to provide expertise, guidance, coordination, and technical direction to staff
and outside agencies on complex case inquiries in a timely manner and manage
any urgent coverage needs for a rapid resolution.
_UCLA Health is a world-renowned health system with four award-winning hospitals and dozens of primary care practices, specialty practices, urgent care centers and other ancillary locations throughout metro Los Angeles as well as the David Geffen School of Medicine, which is an internationally-respected center of advanced medical education and research. If you're looking to experience greater challenge and fulfillment in your career, you can at UCLA Health._
Qualifications
Requirements:
+ Strong verbal and written communication skills and active learning skills
+ Initiative and problem solving-solving skills, and time management skills
+ Experience working with low-income, underserved families and children
+ Desire to work with individuals from diverse ethnic, educational, and socioeconomic backgrounds
+ Interest in advocating to promote health care accessibility
+ Oral and written Spanish/English skills
+ Experience with Medi-Cal, Healthy Families, and other public benefits
+ Valid California Drivers License and Proof of Auto Insurance
+ Ability to learn complex policies and program rules of all the public health insurance programs
UCLA is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veteran status.
UCLA Health welcomes all individuals, without regard to race, sex, sexual orientation, gender identity, religion, national origin or disabilities, and we proudly look to each person's unique achievements and experiences to further set us apart.
Venice Family Clinic is a
leader in providing comprehensive, high-quality primary health care to people
in need with compassion, dignity and respect. In November 2021, Venice Family
Clinic merged with South Bay Family Health Care, uniting more than a century of
experience helping patients regardless of their income, insurance or
immigration status. The organization now has more than 500 staff who serve
45,000 people from the Santa Monica Mountains through the South Bay. We have 17
locations plus two mobile clinics and an expansive street medicine program for
people experiencing homelessness. Read more about us at venicefamilyclinic.org.
Under the direct supervision
of the Health Insurance Program Manager, the Senior Health Insurance (HIE)
Specialist will provide high quality screening/enrollment to patients and
provide advocacy accessing and utilizing services. The Senior HIE Specialist
will be able to properly determine the degree of case urgency and create an
appropriate resolution plan. The Senior HIE Specialist should be knowledgeable
of current Public Health Insurance and other public benefit programs (e.g. Cal Fresh/SNAP)
in order to respond to clients and outside agencies regarding Medi-cal, Covered
CA, My Health LA, Cal Fresh and other health access concerns. They will be able
to provide expertise, guidance, coordination, and technical direction to staff
and outside agencies on complex case inquiries in a timely manner and manage
any urgent coverage needs for a rapid resolution.
_UCLA Health is a world-renowned health system with four award-winning hospitals and dozens of primary care practices, specialty practices, urgent care centers and other ancillary locations throughout metro Los Angeles as well as the David Geffen School of Medicine, which is an internationally-respected center of advanced medical education and research. If you're looking to experience greater challenge and fulfillment in your career, you can at UCLA Health._
Qualifications
Requirements:
+ Strong verbal and written communication skills and active learning skills
+ Initiative and problem solving-solving skills, and time management skills
+ Experience working with low-income, underserved families and children
+ Desire to work with individuals from diverse ethnic, educational, and socioeconomic backgrounds
+ Interest in advocating to promote health care accessibility
+ Oral and written Spanish/English skills
+ Experience with Medi-Cal, Healthy Families, and other public benefits
+ Valid California Drivers License and Proof of Auto Insurance
+ Ability to learn complex policies and program rules of all the public health insurance programs
UCLA is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veteran status.
UCLA Health welcomes all individuals, without regard to race, sex, sexual orientation, gender identity, religion, national origin or disabilities, and we proudly look to each person's unique achievements and experiences to further set us apart.
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Updated March 14, 2024
Updated March 14, 2024