What does an insurance specialist do?

An insurance specialist is an individual responsible for interpreting insurance plans and providing risk management advice to clients and wealth managers. Insurance specialists must have a full understanding of risk management to craft a comprehensive solution that integrates well with the client's portfolio. They need to manage their clients' accounts and should maintain contact with clients after the application process. Insurance specialists must ensure that government insurance programs comply with federal laws, regulations, and contracts within the healthcare industry.
Insurance specialist responsibilities
Here are examples of responsibilities from real insurance specialist resumes:
- Manage database by processing renewals and endorsements.
- Maintain confidentiality and adhere HIPPA guidelines with handling patients' information
- Make recommendations on operationalization and oversight of specific marketplace enrollment policies.
- Verify various health insurance plan benefit information and eligibility for patients with chronic illnesses.
- Identify third party patient eligibility for Medicaid, Medicare, private insurance and alternate resources.
- Enter and prepare advanced beneficiary notices base on diagnosis and procedure codes for Medicare cover patients.
- Answer incoming calls from patients needing to pre-register.
- Enter ICD-9 codes and process assignment of benefits forms for durable medical equipment.
- Research, process and present quantitative data on marketplace enrollment for specific segments of the U.S. population as assigned.
- Verify in and out of network benefit coverage and see if CPT codes are cover and how they are paid.
- Verify in and out of network benefit coverage and insure that CPT codes are covered and how they are paid.
- Perform support duties including answering phones, processing mail, assisting customers, scanning, photocopying and insurance check processing.
- Assess, communicate and convert benefits to non payroll status for all disable participants and employees on unpaid leave of absence.
- Assist insurance professional teams by performing miscellaneous clerical functions including photocopying, faxing, scanning, word processing, and filing.
- Bill medical insurances including Medicare and Medi-Cal.
Insurance specialist skills and personality traits
We calculated that 18% of Insurance Specialists are proficient in Patients, Customer Service, and Insurance Coverage. They’re also known for soft skills such as Math skills, Organizational skills, and Communication skills.
We break down the percentage of Insurance Specialists that have these skills listed on their resume here:
- Patients, 18%
Performed extensive follow-up for patients after ensuring prior authorization payment approval from third parties for services.
- Customer Service, 11%
Supported customer service department by conducting quality control checks on processed transactions and by providing one-on-one and group mentoring for representatives.
- Insurance Coverage, 4%
Verified Insurance coverage/referrals and appropriate authorizations
- Insurance Verification, 4%
Obtained insurance verification and medical benefit authorization with regard to outpatient care, including benefits for evaluation, treatment and testing.
- Life Insurance, 4%
Deepened existing client relationships by counseling partnering agents and financial services experts with new and cutting-edge life insurance products.
- Data Entry, 4%
Filing*Faxing*Processed Insurance Claims*Data Entry*Multi-Line Phone System*Charting*Patient Check-In/Out*Process Payments Patient/Insurance*Appointment Scheduling
"patients," "customer service," and "insurance coverage" are among the most common skills that insurance specialists use at work. You can find even more insurance specialist responsibilities below, including:
Math skills. To carry out their duties, the most important skill for an insurance specialist to have is math skills. Their role and responsibilities require that "the job duties of financial clerks includes calculating charges and updating financial records." Insurance specialists often use math skills in their day-to-day job, as shown by this real resume: "performed daily data entry and compiled statistics to generate a variety of reports for administrators. "
Organizational skills. Another essential skill to perform insurance specialist duties is organizational skills. Insurance specialists responsibilities require that "financial clerks must be able to arrange files so they can find them quickly and efficiently." Insurance specialists also use organizational skills in their role according to a real resume snippet: "demonstrated excellent organizational skills in a fast-paced, upbeat customer service driven business. "
Communication skills. insurance specialists are also known for communication skills, which are critical to their duties. You can see how this skill relates to insurance specialist responsibilities, because "financial clerks should be able to explain policies and procedures to colleagues and customers." An insurance specialist resume example shows how communication skills is used in the workplace: "managed patient accounts through the direct communication with insurance payors, verifying the status of submitted claims. "
The three companies that hire the most insurance specialists are:
- CDM Smith211 insurance specialists jobs
- Family First Life121 insurance specialists jobs
- GPAC57 insurance specialists jobs
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Insurance specialist vs. Billing and insurance coordinator
A billing and insurance coordinator is responsible for coordinating with employees from different departments of an organization for billing and insurance processing purposes. Billing and insurance coordinators sort mail for distribution to appropriate personnel, performing administrative and clerical duties as needed, managing and releasing of invoices under the manager's supervision, and responding to employees' inquiries and concerns. A billing and insurance coordinator must be highly analytical, as well as have excellent knowledge of the insurance disciplines and processes to assist the employees with their payments and benefits.
There are some key differences in the responsibilities of each position. For example, insurance specialist responsibilities require skills like "exceptional client," "life insurance," "health insurance," and "insurance policies." Meanwhile a typical billing and insurance coordinator has skills in areas such as "billing system," "work ethic," "strong work ethic," and "customer accounts." This difference in skills reveals the differences in what each career does.
Billing and insurance coordinators really shine in the professional industry with an average salary of $58,069. Comparatively, insurance specialists tend to make the most money in the government industry with an average salary of $38,343.The education levels that billing and insurance coordinators earn slightly differ from insurance specialists. In particular, billing and insurance coordinators are 0.6% less likely to graduate with a Master's Degree than an insurance specialist. Additionally, they're 0.2% less likely to earn a Doctoral Degree.Insurance specialist vs. Authorization specialist
An authorization specialist is responsible for reviewing insurance claims and determining the necessary settlement for the clients and involved parties. Authorization specialists file documents and gather the required information for further investigation and analysis. They coordinate with the insurance agency and the medical institution and ensure that the correct communications are being sent out for reference. An authorization specialist must have excellent communication and organizational skills, especially in writing authorization requests and resolve claims timely and efficiently.
While some skills are similar in these professions, other skills aren't so similar. For example, resumes show us that insurance specialist responsibilities requires skills like "exceptional client," "life insurance," "health insurance," and "insurance claims." But an authorization specialist might use other skills in their typical duties, such as, "veterans," "home health," "clinical data," and "medical services."
Authorization specialists earn a higher average salary than insurance specialists. But authorization specialists earn the highest pay in the health care industry, with an average salary of $35,974. Additionally, insurance specialists earn the highest salaries in the government with average pay of $38,343 annually.Average education levels between the two professions vary. Authorization specialists tend to reach similar levels of education than insurance specialists. In fact, they're 1.3% less likely to graduate with a Master's Degree and 0.2% less likely to earn a Doctoral Degree.Insurance specialist vs. Scheduling specialist
A scheduling specialist is responsible for managing the department's meeting, conference, and event schedules, as well as negotiating with suppliers and third-party vendors for appointment and program needs. Scheduling specialists may also perform administrative and clerical duties as needed, especially on communicating with clients and informing them of meetings, and responding to their concerns and inquiries. A scheduling specialist must have excellent communication and organizational skills, as well as knowledge of the data processing procedures to maintain the organization's database, updating clients' information, and tracking business transactions.
Some important key differences between the two careers include a few of the skills necessary to fulfill the responsibilities of each. Some examples from insurance specialist resumes include skills like "exceptional client," "life insurance," "insurance claims," and "insurance policies," whereas a scheduling specialist is more likely to list skills in "home health," "patient care," "excellent interpersonal," and "phone calls. "
Scheduling specialists earn the best pay in the transportation industry, where they command an average salary of $51,929. Insurance specialists earn the highest pay from the government industry, with an average salary of $38,343.When it comes to education, scheduling specialists tend to earn similar degree levels compared to insurance specialists. In fact, they're 0.3% less likely to earn a Master's Degree, and 0.2% less likely to graduate with a Doctoral Degree.Insurance specialist vs. Insurance representative
An insurance representative serves as a client's point of contact in insurance companies. Their responsibilities include researching client opportunities, reaching out to potential clients to offer products and services, discussing terms and policies, providing detailed advice, and assisting in every procedure, ensuring convenience and client satisfaction. Aside from securing sales, an insurance representative may also process applications and claims while adhering to the company's policies and regulations. Furthermore, they may also perform clerical tasks such as handling calls and correspondence, arranging appointments, and maintaining records of all transactions.
Types of insurance specialist
Updated January 8, 2025











