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Health insurance specialist skills for your resume and career

Updated January 8, 2025
4 min read
Quoted expert
Li Zhang Ph.D.
Below we've compiled a list of the most critical health insurance specialist skills. We ranked the top skills for health insurance specialists based on the percentage of resumes they appeared on. For example, 13.8% of health insurance specialist resumes contained patients as a skill. Continue reading to find out what skills a health insurance specialist needs to be successful in the workplace.

15 health insurance specialist skills for your resume and career

1. Patients

Here's how health insurance specialists use patients:
  • Managed communication points between corporate advisers, providers and patients for medical service advisory requests.
  • Assisted patients by explaining insurance benefits and available resources.

2. Medicaid

Here's how health insurance specialists use medicaid:
  • Coordinated and conducted training on Medicare and Medicaid to new physicians and resident medical students as part of a National Outreach Initiative
  • Analyze Medicaid and section 1115 policies, precedence and operations to evaluate appropriateness, effectiveness, cost-effectiveness and/or other impacts.

3. CMS

A Content Management System or CMS is computer software that works as a framework where content can be assembled and managed by using a database. CMS is an important asset in web development. This platform enables users to create, edit, collaborate on, publish and store digital content. It helps users to manage their content and modify it from a single system.

Here's how health insurance specialists use cms:
  • Insured compliance of CMS regulatory standards and policies for participating provider Hospitals in Illinois.
  • Participated development of CMS policy, including implementing regulations and administrative actions.

4. Health Insurance

Here's how health insurance specialists use health insurance:
  • Contribute to conversations regarding policies, instructions and procedures related to Health Insurance Eligibility and Enrollment market performance.
  • Evaluate health care delivery or payment models to examine implications on health insurance policy or regulations.

5. HIPAA

Here's how health insurance specialists use hipaa:
  • Earned HIPAA compliance to view and handle confidential patient medical charts.
  • Develop policies and procedures for compliance with HIPAA.

6. Insurance Coverage

Here's how health insurance specialists use insurance coverage:
  • Determined the insurance coverage and payable claim amount.
  • Conducted pre-verification for providers on customers insurance coverage.

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7. HHS

Here's how health insurance specialists use hhs:
  • Participated in all trainings, as assigned by the Department of Health and Human Services (HHS).

8. Insurance Eligibility

Here's how health insurance specialists use insurance eligibility:
  • Examined claims and verified insurance eligibility as well other clerical duties.
  • Verified patient forms and insurance eligibility.

9. Data Entry

Data entry means entering data into a company's system with the help of a keyboard. A person responsible for entering data may also be asked to verify the authenticity of the data being entered. A person doing data entry must pay great attention to tiny details.

Here's how health insurance specialists use data entry:
  • Perform various administrative duties as assigned including data entry.
  • Process data entry activities of pertinent information received at different points of contact during the delivery of program services.

10. Insurance Policies

Here's how health insurance specialists use insurance policies:
  • Marketed, sold and serviced Medicare supplement insurance policies; created and maintained computer files
  • Explained various insurance policies and helped clients choose appropriate plans.

11. Phone Calls

Phone calls are a wireless or wired connection made over a telephone or a mobile phone between two people. Two parties are involved in a phone call, the caller and the receiver. A caller dials the number of the one he wants to call, and the recipient hears a bell or a tune to which he picks up the call. The call establishes a connection between them through which they can communicate. The voice is converted into signals and is transmitted through wired or wireless technology.

Here's how health insurance specialists use phone calls:
  • Handled all incoming appeals that were received via emails; answered and received phone calls from members pertaining to appeals.
  • Attend to both inbound and outbound telephone calls/contacts in accordance with the standard operating procedures.

12. Customer Service

Customer service is the process of offering assistance to all the current and potential customers -- answering questions, fixing problems, and providing excellent service. The main goal of customer service is to build a strong relationship with the customers so that they keep coming back for more business.

Here's how health insurance specialists use customer service:
  • Provide customer services to beneficiary, providers by working collaboratively within the agency and external stakeholders.
  • Provided effective and timely customer service related to routine and complex benefits issues.

13. Technical Assistance

Technical assistance is the non-financial assistance provided by local or international specialists. The purpose of technical assistance is to maximize the project's implementation and quality of the final product. Technical assistance consists of sharing information, the transmission of working knowledge, and other transfer of technical data which would aid the administration, management team and help build the project. The technical assistance focuses on particular needs identified by the beneficiary country and is delivered in the form of missions.

Here's how health insurance specialists use technical assistance:
  • Identify opportunities for other technical assistance to the States and develops methods and procedures to effectively provide such technical assistance.
  • Provide policy leadership and technical assistance to states by supporting system-wide payment and delivery system reform innovation.

14. Policy Issues

Policy issues are key issues that influence the economic, social, and political life of a place where conflicts arise over the direction of government policy. Often the policy issues are general, dealing with broad approaches to problems, such as whether the federal government should increase spending on national defense or whether social security should be privatized in some fashion.

Here's how health insurance specialists use policy issues:
  • Evaluated the impact of current and potential legislation on Part B ASP drug payment policy issues.
  • Conducted analyses of policy issues related to Medicare Parts C&D fraud.

15. Inbound Calls

Here's how health insurance specialists use inbound calls:
  • Maintained a book of business utilizing a CRM and through various outbound and inbound calls.
  • Worked on Uniphi dialer making outbound and taking inbound calls.
top-skills

What skills help Health Insurance Specialists find jobs?

Tell us what job you are looking for, we’ll show you what skills employers want.

What soft skills should all health insurance specialists possess?

Li Zhang Ph.D.

Professor, St. Cloud State University

I'd say communication skills. Many positions in insurance need to interact with others. The ability to listen carefully and responding effectively, conveying thoughts/ideas fluently is very important. Also, communicating throng writing is also important (it could range from simply completing the paperwork accurately to preparing annual reports for supervisors)
Do you want to know more?
Read more about what experts have to say about health insurance specialist

List of health insurance specialist skills to add to your resume

Health insurance specialist skills

The most important skills for a health insurance specialist resume and required skills for a health insurance specialist to have include:

  • Patients
  • Medicaid
  • CMS
  • Health Insurance
  • HIPAA
  • Insurance Coverage
  • HHS
  • Insurance Eligibility
  • Data Entry
  • Insurance Policies
  • Phone Calls
  • Customer Service
  • Technical Assistance
  • Policy Issues
  • Inbound Calls
  • Computer System
  • Outbound Calls
  • Insurance Carriers
  • Medical Billing
  • CPT
  • Appeals
  • Marketplace
  • Educational Materials
  • Federal Regulations
  • External Stakeholders
  • Oversight
  • Customer Inquiries
  • Issue Papers
  • Medical Terminology
  • ACA
  • Insurance Claims
  • Hippa
  • Medicare Advantage
  • State Agencies
  • Training Materials
  • Life Insurance
  • ICD-9
  • Contractor Performance
  • CMMI
  • Medical Claims
  • Medicare Part D
  • Public Comments
  • State Plan
  • HMO
  • EOB
  • Policy Changes
  • COR
  • Medical Benefits
  • CHCS

Updated January 8, 2025

Zippia Research Team
Zippia Team

Editorial Staff

The Zippia Research Team has spent countless hours reviewing resumes, job postings, and government data to determine what goes into getting a job in each phase of life. Professional writers and data scientists comprise the Zippia Research Team.

Updated January 8, 2025

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