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What does a health insurance specialist do?

Updated January 8, 2025
7 min read

A health insurance specialist uses electronic records of patients to evaluate insurance claims and code medical procedures. They are often hired by healthcare facilities to deal with the health insurance of patients. Therefore, they are responsible for medical records, co-payment details, and payment and billing details. Most hospitals and health care facilities employ the services of a health insurance specialist to ensure they are paid promptly and to clear all outstanding charges owed to the facility.

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Health insurance specialist responsibilities

Here are examples of responsibilities from real health insurance specialist resumes:

  • Manage communication points between corporate advisers, providers and patients for medical service advisory requests.
  • Handle diverse phone calls and confidential information following all HIPAA guidelines.
  • Proofread and issue travel documents.
  • Proofread policy material concerning insurance programs and substantiate computations premiums due.
  • Evaluate the effectiveness of existing policies and review new policy and legislative initiatives for potential impact on Medicaid programs.
  • Participate in and provide specific and detail information regarding operational policy, instructions, and procedures for Medicaid programs.
  • Maintain data integrity between parallel systems, including auditing and reconciling payroll and benefits interface discrepancy and edit reports.
  • Advise and enroll customers in programs primarily with AFLAC, but also with various other health care providers.
  • Educate business owners/decision makers on benefits of offering AFLAC products for employees, educate individuals on benefits of AFLAC and WellCare products
  • Provide verbal information regarding the available Humana plans.
  • Consult and sell Humana prescription drug plans to Medicare recipients
  • Process new and renewing business utilizing the BlueStar membership system.

Health insurance specialist skills and personality traits

We calculated that 14% of Health Insurance Specialists are proficient in Patients, Medicaid, and CMS. They’re also known for soft skills such as Initiative, Self-confidence, and Communication skills.

We break down the percentage of Health Insurance Specialists that have these skills listed on their resume here:

  • Patients, 14%

    Managed communication points between corporate advisers, providers and patients for medical service advisory requests.

  • Medicaid, 11%

    Coordinated and conducted training on Medicare and Medicaid to new physicians and resident medical students as part of a National Outreach Initiative

  • CMS, 9%

    Insured compliance of CMS regulatory standards and policies for participating provider Hospitals in Illinois.

  • Health Insurance, 6%

    Contribute to conversations regarding policies, instructions and procedures related to Health Insurance Eligibility and Enrollment market performance.

  • HIPAA, 5%

    Earned HIPAA compliance to view and handle confidential patient medical charts.

  • Insurance Coverage, 5%

    Determined the insurance coverage and payable claim amount.

"patients," "medicaid," and "cms" are among the most common skills that health insurance specialists use at work. You can find even more health insurance specialist responsibilities below, including:

Initiative. One of the key soft skills for a health insurance specialist to have is initiative. You can see how this relates to what health insurance specialists do because "insurance sales agents need to actively seek out new clients in order to increase business." Additionally, a health insurance specialist resume shows how health insurance specialists use initiative: "coordinate training initiatives for cms central/regional office staff and external partners. "

Self-confidence. Another essential skill to perform health insurance specialist duties is self-confidence. Health insurance specialists responsibilities require that "insurance sales agents should be confident when contacting prospective clients." Health insurance specialists also use self-confidence in their role according to a real resume snippet: "complied with hippa privacy regulations and maintained confidentiality at all times. "

Communication skills. Another skill that relates to the job responsibilities of health insurance specialists is communication skills. This skill is critical to many everyday health insurance specialist duties, as "insurance sales agents must listen to clients and be able to clearly explain suitable policies." This example from a resume shows how this skill is used: "develop educational or training materials to make improvements on communications products or health care programs provided to the public. "

Analytical skills. A big part of what health insurance specialists do relies on "analytical skills." You can see how essential it is to health insurance specialist responsibilities because "insurance sales agents must evaluate the needs of each client to determine the appropriate insurance policy." Here's an example of how this skill is used from a resume that represents typical health insurance specialist tasks: "work medicare remittance denials and analyze patient accounts and review eob's work rejections and perform proper reimbursement analysis"

Most common health insurance specialist skills

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Compare different health insurance specialists

Health insurance specialist vs. Agent

Agents are individuals who are employed by their clients to represent them in various dealings. Agents are usually employed by people in the show business industry, such as actors, writers, or directors. They meet people who are interested in dealing with their clients. They listen to the plans and vision for the project and assess if the project fits their clients' interests or public image. In the case of agents whose clients are actors, they send their clients to auditions upon review of the project details. Agents are also responsible for negotiating terms on behalf of their clients, such as salary, royalties, and set benefits, among others. They also inform the project leaders of their clients' demands on set. Agents are expected to be business-savvy and good negotiators.

If we compare the average health insurance specialist annual salary with that of an agent, we find that agents typically earn a $22,737 lower salary than health insurance specialists make annually.Even though health insurance specialists and agents are distinct careers, a few of the skills required for both jobs are similar. For example, both careers require health insurance, insurance policies, and customer service in the day-to-day roles and responsibilities.

These skill sets are where the common ground ends though. The responsibilities of a health insurance specialist are more likely to require skills like "patients," "medicaid," "cms," and "hipaa." On the other hand, a job as an agent requires skills like "insurance products," "hr," "financial services," and "real estate." As you can see, what employees do in each career varies considerably.

The education levels that agents earn slightly differ from health insurance specialists. In particular, agents are 9.4% less likely to graduate with a Master's Degree than a health insurance specialist. Additionally, they're 1.4% less likely to earn a Doctoral Degree.

Health insurance specialist vs. Field agent

Field agents are the ones who work and do their job not inside the four corners of the office; instead, they do the assigned task outside. They often are expected to have good communication skills so that they can get a response from the most unwilling person in the area. Besides, they must also possess good character traits and professionalism to effectively address higher-up's concerns. As the man on the field, they provide customer support more effectively.

Field agent positions earn lower pay than health insurance specialist roles. They earn a $23,277 lower salary than health insurance specialists per year.

In addition to the difference in salary, there are some other key differences worth noting. For example, health insurance specialist responsibilities are more likely to require skills like "patients," "medicaid," "cms," and "hipaa." Meanwhile, a field agent has duties that require skills in areas such as "gps," "long-term care," "annuities," and "subpoenas." These differences highlight just how different the day-to-day in each role looks.

Field agents earn a lower average salary than health insurance specialists. But field agents earn the highest pay in the finance industry, with an average salary of $53,420. Additionally, health insurance specialists earn the highest salaries in the finance with average pay of $75,595 annually.In general, field agents achieve lower levels of education than health insurance specialists. They're 8.4% less likely to obtain a Master's Degree while being 1.4% less likely to earn a Doctoral Degree.

Health insurance specialist vs. Lead agent

Lead agents assist with passenger-cargo acceptance and check-in and promote and sell air travel tickets to freight forwarders or the traveling public. Besides promoting safe travel and protecting the firm revenue and property, lead agents also assist distressed traveling customers. Also, lead agents interpret government rules to be observed for travel and cargo shipments. These professionals meet and dispatch aircraft within the required times and use their motor skills to complete related tasks.

On average scale, lead agents bring in lower salaries than health insurance specialists. In fact, they earn a $13,257 lower salary per year.Using the responsibilities included on health insurance specialists and lead agents resumes, we found that both professions have similar skill requirements, such as "customer service," "inbound calls," and "computer system.rdquo;

The required skills of the two careers differ considerably. For example, health insurance specialists are more likely to have skills like "patients," "medicaid," "cms," and "health insurance." But a lead agent is more likely to have skills like "team support," "customer care," "vip," and "customer complaints."

Lead agents typically earn lower educational levels compared to health insurance specialists. Specifically, they're 10.2% less likely to graduate with a Master's Degree, and 1.7% less likely to earn a Doctoral Degree.

Health insurance specialist vs. Marketing agent

A marketing agency is responsible for selling the company's goods and services, identifying promotional techniques to boost brand awareness in the market, and strategizing in increasing sales targets. Marketing agents identify business opportunities by analyzing market trends and public demands that would generate more revenue resources and increase the company's profitability. They also negotiate with potential clients for partnerships, respond to their inquiries and concerns, and address their requests. A marketing agent handles the development of marketing materials, including a budget allocation to support marketing functions and business requirements.

Marketing agents tend to earn a lower pay than health insurance specialists by an average of $20,217 per year.While both health insurance specialists and marketing agents complete day-to-day tasks using similar skills like customer service, inbound calls, and outbound calls, the two careers vary in some skills.

Even though a few skill sets overlap between health insurance specialists and marketing agents, there are some differences that are important to note. For one, a health insurance specialist might have more use for skills like "patients," "medicaid," "cms," and "health insurance." Meanwhile, some responsibilities of marketing agents require skills like "booking," "product knowledge," "digital marketing," and "marketing presentations. "

The hospitality industry tends to pay the highest salaries for marketing agents, with average annual pay of $50,749. Comparatively, the highest health insurance specialist annual salary comes from the finance industry.The average resume of marketing agents showed that they earn lower levels of education compared to health insurance specialists. So much so that theyacirc;euro;trade;re 8.7% less likely to earn a Master's Degree and less likely to earn a Doctoral Degree by 1.7%.

Types of health insurance specialist

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.