Post job

What does an insurance verification specialist do?

Updated January 8, 2025
7 min read
What does an insurance verification specialist do

An insurance verification specialist is responsible for confirming a patient's insurance details and eligibility to receive medical care services. Insurance verification specialists review the insurance documents of the patients, including its coverage and limitations, and escalate concerns to the supervisor for immediate resolution. They process paperwork accordingly upon coordinating with the patients and attending health professionals. An insurance verification specialist must have excellent communication and organizational skills, finishing administrative tasks efficiently under minimal supervision.

On this page

Insurance verification specialist responsibilities

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

  • Check CPT and ICD-10 codes with LCD and policies from multiple insurance companies to make sure procedures will be paid.
  • Support the patient privacy/confidentiality policies and regulations under HIPAA for patients and their medical records.
  • Confirm correct charges base on HCPCS codes.
  • Assist callers as well with questions about their benefits, terms and conditions of medical plans, appeals and grievances.
  • Provide medical record support in the absence of EMR: assist clinics and hospitals in obtaining medical records in appropriate format.
  • Document outbound communication from providers and veterans.
  • Verify cardiovascular CPT codes and request prior authorizations.
  • Organize with documents and entering information into EMR using EclinicalWorks.
  • Maintain confidentiality of all information; adhere to HIPPA guidelines/regulations.
  • Create appointment encounters for both laboratory and radiology departments for patients.
  • Register patients for radiology, lab work, cardiovascular and respiratory testing.
  • Maintain confidentiality of patient's personal and medical information according to HIPPA regulations.
  • Access government insurance benefits including Medicaid and Medicare online to verify patient benefit information.
  • Correct and review Medicaid override forms for staff prior to delivery to Medicaid representatives.
  • Maintain confidentiality of all information; adheres to all HIPAA guidelines/regulations and facility procedures and guidelines.

Insurance verification specialist skills and personality traits

We calculated that 25% of Insurance Verification Specialists are proficient in Patients, Insurance Verification, and Customer Service. They’re also known for soft skills such as Initiative, Self-confidence, and Analytical skills.

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

  • Patients, 25%

    Verify patients' medical insurance for upcoming medical appointments by using internet websites or contacting insurance companies by phone.

  • Insurance Verification, 15%

    Worked as Outpatient Insurance Verification specialist responsible for insurance verification on all outpatient services scheduled at Mary Washington and Stafford Hospital.

  • Customer Service, 7%

    Provided the highest quality customer service internally and externally to customers by maintaining proper standards for provider and customer interactions.

  • Insurance Eligibility, 5%

    Position included verifying insurance eligibility and coverage with insurance companies and coordinating with scheduling and insurance billing departments.

  • Data Entry, 4%

    Verified insurance coverage for durable medical equipment Data entry Maintained timely communication with 15 designated representatives via email and phone.

  • Medical Terminology, 4%

    Advanced understanding and extensive knowledge of medical terminology and insurance billing requirements.

Common skills that an insurance verification specialist uses to do their job include "patients," "insurance verification," and "customer service." You can find details on the most important insurance verification specialist responsibilities below.

Initiative. One of the key soft skills for an insurance verification specialist to have is initiative. You can see how this relates to what insurance verification specialists do because "insurance sales agents need to actively seek out new clients in order to increase business." Additionally, an insurance verification specialist resume shows how insurance verification specialists use initiative: "performed voluntary customer service as needed to enhance customer satisfaction -commended for initiative, customer satisfaction, and dependability. "

Self-confidence. Another soft skill that's essential for fulfilling insurance verification specialist duties is self-confidence. The role rewards competence in this skill because "insurance sales agents should be confident when contacting prospective clients." According to an insurance verification specialist resume, here's how insurance verification specialists can utilize self-confidence in their job responsibilities: "educated in keeping patient accounts confidential with hippa regulations. "

Analytical skills. insurance verification specialists are also known for analytical skills, which are critical to their duties. You can see how this skill relates to insurance verification specialist responsibilities, because "insurance sales agents must evaluate the needs of each client to determine the appropriate insurance policy." An insurance verification specialist resume example shows how analytical skills is used in the workplace: "verified insurance claims data input,"

Communication skills. A big part of what insurance verification specialists do relies on "communication skills." You can see how essential it is to insurance verification specialist responsibilities because "insurance sales agents must listen to clients and be able to clearly explain suitable policies." Here's an example of how this skill is used from a resume that represents typical insurance verification specialist tasks: "direct communication with insurance claims adjusters regarding authorizations. "

Most common insurance verification specialist skills

Choose from 10+ customizable insurance verification specialist resume templates

Build a professional insurance verification specialist resume in minutes. Our AI resume writing assistant will guide you through every step of the process, and you can choose from 10+ resume templates to create your insurance verification specialist resume.
Insurance Verification Specialist Resume
Insurance Verification Specialist Resume
Insurance Verification Specialist Resume
Insurance Verification Specialist Resume
Insurance Verification Specialist Resume
Insurance Verification Specialist Resume
Insurance Verification Specialist Resume
Insurance Verification Specialist Resume
Insurance Verification Specialist Resume
Insurance Verification Specialist Resume
Insurance Verification Specialist Resume
Insurance Verification Specialist Resume
Insurance Verification Specialist Resume
Insurance Verification Specialist Resume
Insurance Verification Specialist Resume
Insurance Verification Specialist Resume

Compare different insurance verification specialists

Insurance verification 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.

If we compare the average insurance verification specialist annual salary with that of a scheduling specialist, we find that scheduling specialists typically earn a $4,226 higher salary than insurance verification specialists make annually.While their salaries may differ, the common ground between insurance verification specialists and scheduling specialists are a few of the skills required in each roleacirc;euro;trade;s responsibilities. In both careers, employee duties involve skills like patients, insurance verification, and customer service.

There are some key differences in the responsibilities of each position. For example, insurance verification specialist responsibilities require skills like "patient insurance coverage," "medical procedures," "insurance carriers," and "authorization process." Meanwhile a typical scheduling specialist has skills in areas such as "patient care," "excellent interpersonal," "insurance coverage," and "compassion." This difference in skills reveals the differences in what each career does.

Scheduling specialists tend to make the most money working in the transportation industry, where they earn an average salary of $51,929. In contrast, insurance verification specialists make the biggest average salary, $35,651, in the pharmaceutical industry.On average, scheduling specialists reach similar levels of education than insurance verification specialists. Scheduling specialists are 2.3% more likely to earn a Master's Degree and 0.0% less likely to graduate with a Doctoral Degree.

Insurance verification specialist vs. Life insurance agent

A life insurance agent is responsible for offering life insurance services for clients according to their needs and qualifications. Life insurance agents handle insurance claims of the beneficiaries, ensuring the accuracy of documents and account statements for verification. They also discuss possible options and alternatives, as well as considering the clients' long-term financial goals and objectives. A life insurance agent must be well-knowledgeable of the insurance services offered by the company, discussing policies and coverage to suit the clients' best interests.

Life insurance agent positions earn higher pay than insurance verification specialist roles. They earn a $29,509 higher salary than insurance verification specialists per year.While the salary may differ for these jobs, they share a few skills needed to perform their duties. Based on resume data, both insurance verification specialists and life insurance agents have skills such as "customer service," "health insurance," and "outbound calls. "

While some skills are similar in these professions, other skills aren't so similar. For example, resumes show us that insurance verification specialist responsibilities requires skills like "patients," "insurance verification," "insurance eligibility," and "data entry." But a life insurance agent might use other skills in their typical duties, such as, "life insurance license," "life insurance sales," "work ethic," and "strong work ethic."

Life insurance agents may earn a higher salary than insurance verification specialists, but life insurance agents earn the most pay in the insurance industry with an average salary of $65,179. On the other hand, insurance verification specialists receive higher pay in the pharmaceutical industry, where they earn an average salary of $35,651.In general, life insurance agents achieve similar levels of education than insurance verification specialists. They're 3.7% more likely to obtain a Master's Degree while being 0.0% more likely to earn a Doctoral Degree.

Insurance verification specialist vs. Specialist

Specialists are employees who are responsible for specific tasks or activities in the department they are assigned to. The actions or tasks they work on are related to their educational background or work experiences. They are usually highly skilled in specializations related to the work they are assigned to. Specialists are also highly trained on the competencies that are required of their specialty. As such, they are focused on the skills and competencies that are needed to enhance their experience in their specific field further.

On average, specialists earn higher salaries than insurance verification specialists, with a $24,970 difference per year.Using the responsibilities included on insurance verification specialists and specialists resumes, we found that both professions have similar skill requirements, such as "patients," "customer service," and "medicaid.rdquo;

There are many key differences between these two careers, including some of the skills required to perform responsibilities within each role. For example, an insurance verification specialist is likely to be skilled in "insurance verification," "insurance eligibility," "data entry," and "medical terminology," while a typical specialist is skilled in "work ethic," "patient care," "exceptional client," and "troubleshoot."

Specialists typically earn higher educational levels compared to insurance verification specialists. Specifically, they're 5.2% more likely to graduate with a Master's Degree, and 0.5% more likely to earn a Doctoral Degree.

Insurance verification specialist vs. Billing specialist

Billing specialists are accounting or finance employees who are responsible for sending out billing invoices to clients. They calculate charges that their clients have incurred. They then write bills, ensure that all details are correct, and send these out to clients. They also manage payment due dates and ensure that clients are duly reminded of such deadlines. Billing specialists also manage client accounts and ensure that they are paying on time. They help identify clients who have outstanding payables and send out collection notices to them. At times, billing specialists also manage the receipt of payments to manage account records better.

Billing specialists tend to earn a higher pay than insurance verification specialists by an average of $2,581 per year.According to resumes from insurance verification specialists and billing specialists, some of the skills necessary to complete the responsibilities of each role are similar. These skills include "patients," "insurance verification," and "customer service. "

Even though a few skill sets overlap between insurance verification specialists and billing specialists, there are some differences that are important to note. For one, an insurance verification specialist might have more use for skills like "health insurance," "phone calls," "patient insurance coverage," and "medical procedures." Meanwhile, some responsibilities of billing specialists require skills like "submit claims," "billing issues," "appeals," and "billing statements. "

Billing specialists enjoy the best pay in the manufacturing industry, with an average salary of $37,417. For comparison, insurance verification specialists earn the highest salary in the pharmaceutical industry.In general, billing specialists hold similar degree levels compared to insurance verification specialists. Billing specialists are 0.6% more likely to earn their Master's Degree and 0.1% less likely to graduate with a Doctoral Degree.

Types of insurance verification 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.