Insurance verification representative vs verification specialist

The differences between insurance verification representatives and verification specialists can be seen in a few details. Each job has different responsibilities and duties. While it typically takes 2-4 years to become an insurance verification representative, becoming a verification specialist takes usually requires 4-6 years. Additionally, an insurance verification representative has an average salary of $32,706, which is higher than the $31,564 average annual salary of a verification specialist.

The top three skills for an insurance verification representative include patients, insurance verification and customer service. The most important skills for a verification specialist are customer service, patients, and data entry.

Insurance verification representative vs verification specialist overview

	Insurance Verification Representative	Verification Specialist
Yearly salary	$32,706	$31,564
Hourly rate	$15.72	$15.18
Growth rate	-4%	7%
Number of jobs	150,260	26,348
Job satisfaction	-	5
Most common degree	Bachelor's Degree, 28%	Bachelor's Degree, 37%
Average age	40	45
Years of experience	4	6

What does an insurance verification representative do?

An insurance verification representative is responsible for ensuring the coverage of a patient's healthcare benefits by required procedures. Your duties will typically include updating patient information, verifying insurance coverage of patients, and arranging payment for medical services that are not covered under insurance. In addition, you will be checking eligibility and benefits for healthcare providers and explaining Medicare and CMS guidelines as needed. As an insurance verification representative, you are also expected to advise and discuss various financing options that best fit a patient's budget.

What does a verification specialist do?

The verification specialist's primary role is to make and take calls to employers for the purpose of verifying information stated by an applicant on his/her /her job application. They manage calls inbound/outbound for education, employment, reference, and licensing verification purposes. They also maintain and keep records of all calls handled to ensure all verifications made are followed upon on time. They communicate effectively and proficiently to all parties involved in attaining verification information. Moreover, they do monthly review to quality check all data gathered for verifications.

Insurance verification representative vs verification specialist salary

Insurance verification representatives and verification specialists have different pay scales, as shown below.

	Insurance Verification Representative	Verification Specialist
Average salary	$32,706	$31,564
Salary range	Between $28,000 And $37,000	Between $24,000 And $41,000
Highest paying City	Charleston, WV	San Jose, CA
Highest paying state	Massachusetts	California
Best paying company	Student Conservation Association	Jacobs Engineering Group
Best paying industry	Health Care	Insurance

Differences between insurance verification representative and verification specialist education

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

	Insurance Verification Representative	Verification Specialist
Most common degree	Bachelor's Degree, 28%	Bachelor's Degree, 37%
Most common major	Business	Business
Most common college	Stanford University	University of Pennsylvania

Insurance verification representative vs verification specialist demographics

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

	Insurance Verification Representative	Verification Specialist
Average age	40	45
Gender ratio	Male, 15.1% Female, 84.9%	Male, 23.9% Female, 76.1%
Race ratio	Black or African American, 12.6% Unknown, 4.8% Hispanic or Latino, 22.0% Asian, 6.3% White, 53.8% American Indian and Alaska Native, 0.6%	Black or African American, 11.2% Unknown, 3.7% Hispanic or Latino, 15.2% Asian, 7.3% White, 62.3% American Indian and Alaska Native, 0.4%
LGBT Percentage	7%	9%

Differences between insurance verification representative and verification specialist duties and responsibilities

Insurance verification representative example responsibilities.

Coach, evaluate and performance manage MSRs to ensure timely and accurate service to clients.
Practice confidentiality while handling patients' medical information with use of the HIPAA law.
Verify Medicare, Medicaid, other government agencies and private insurance for new patients to determine their individualize eligibility and benefits.
Verify HMO referrals and treatment plans are authorize.
Have knowledge in difference between HMO and PPO insurance.
Comply with HIPPA due to the nature of client information.

Verification specialist example responsibilities.

Manage the TRICARE information program by presenting information utilizing available media, group presentations, or mailings.
Maintain confidentiality of all patient medical information adhering to HIPPA regulations and Medicare / Medicaid policies.
Verify primary insurance eligibility by phone with agents or online regarding Medicaid recipients and to determine payment responsibilities to providers.
Verify medical coverage and benefits to providers and members, review certain ICD9 and CPT codes.
Verify patient effective date of insurance, including CPT and diagnosis codes and general policy information.
Receive extensive training on insurance plans and types, HIPAA compliance, PatientPlus programming and other workplace relate topics.

Insurance verification representative vs verification specialist skills

Common insurance verification representative skills

Patients, 21%
Insurance Verification, 14%
Customer Service, 11%
Medical Terminology, 6%
Insurance Benefits, 4%
Insurance Eligibility, 4%

Common verification specialist skills

Customer Service, 23%
Patients, 18%
Data Entry, 13%
Insurance Verification, 4%
Medicaid, 4%
Verification Process, 3%

Insurance Verification Representative vs. similar jobs

Insurance Verification Representative related careers

Insurance Verification Representative related jobs

What similar roles do

Zippia Careers
Office and Administrative Industry
Insurance Verification Representative
Insurance Verification Representative vs Verification Specialist

Updated January 8, 2025

Browse office and administrative jobs