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.
Verification specialist responsibilities
Here are examples of responsibilities from real verification specialist resumes:
- 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.
- Guide and train several SIU investigative analysts.
- Handle private personal information in accordance with HIPAA regulations.
- Handle members personal health information accordingly and follow HIPPA regulations.
- Update and maintain patient's demographic information and adhere to HIPPA guidelines/regulations.
- Recognize and report possible misrepresentation and provide assistance to SIU with investigating possible fraud.
- Negotiate and settle professional liability claims including mediation, arbitration, and determination of appropriate settlement authority.
- Collect insurance information from patients via phone and email and assist with admissions process and specific program eligibility.
- Participate in various dispute resolution techniques, including mediation and arbitration, in order to obtain positive outcomes for policyholders.
- Perform a thorough benefit verification to ensure comprehensive verification for patients regarding coverage requirements and payment levels for the proper therapy.
Verification specialist skills and personality traits
We calculated that 23% of Verification Specialists are proficient in Customer Service, Patients, and Data Entry. They’re also known for soft skills such as Business skills, Analytical skills, and Communication skills.
We break down the percentage of Verification Specialists that have these skills listed on their resume here:
- Customer Service, 23%
Verify income of independent and dependent student in comparison with filing status and accuracy * Strong Data entry and exceptional customer service
- Patients, 18%
Performed a thorough benefit verification to ensure comprehensive verification for patients regarding coverage requirements and payment levels for the proper therapy.
- Data Entry, 13%
Performed alphanumeric data entry and Internet research in order to accurately verify client contact info.
- Insurance Verification, 4%
Provided professional, accurate, timely insurance verification and notification for outpatient diagnostic services, observation and inpatient services.
- Medicaid, 4%
Verified primary insurance eligibility by phone with agents or online regarding Medicaid recipients and to determine payment responsibilities to providers.
- Verification Process, 3%
Maintain database of college and university institution information ensuring that accurate information is present at all times for the verification process.
Common skills that a verification specialist uses to do their job include "customer service," "patients," and "data entry." You can find details on the most important verification specialist responsibilities below.
Business skills. The most essential soft skill for a verification specialist to carry out their responsibilities is business skills. This skill is important for the role because "specialists must understand basic finance and accounting." Additionally, a verification specialist resume shows how their duties depend on business skills: "provide administrative support to business operations by performing processing tasks such as data entry and verification of confidential documents. "
Analytical skills. Many verification specialist duties rely on analytical skills. "compensation, benefits, and job analysis specialists perform data and cost analyses to evaluate their organization’s policies," so a verification specialist will need this skill often in their role. This resume example is just one of many ways verification specialist responsibilities rely on analytical skills: "ask necessary questions regarding patient's insurance benefits and complete data entry and required reporting documentation using patientplus case management system. "
Communication skills. This is an important skill for verification specialists to perform their duties. For an example of how verification specialist responsibilities depend on this skill, consider that "specialists need to provide information about compensation and benefits in a way that is understandable to employees at all levels throughout their organization." This excerpt from a resume also shows how vital it is to everyday roles and responsibilities of a verification specialist: "respond to customer communication regarding application assistance and renewal of healthcare plans for united healthcare and humana customers. ".
The three companies that hire the most verification specialists are:
- CTG214 verification specialists jobs
- Elevance Health
42 verification specialists jobs
- Accurate Background
4 verification specialists jobs
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Compare different verification specialists
Verification specialist vs. Payroll and benefits coordinator
A Payroll and Benefits Coordinator works as a member of a company's human resources department where their role is to oversee and organize procedures related to preparing and processing employee salaries and benefits, ensuring accuracy and timeliness. They are responsible for setting goals and guidelines, maintaining payroll records and employee timesheets, preparing and processing the necessary documentation, liaising with internal and external business partners, delegating tasks among staff, and resolving issues and concerns if any arise. Moreover, as a payroll and benefits coordinator, it is essential to assist employees by answering inquiries and understanding the extent of procedures.
While similarities exist, there are also some differences between verification specialists and payroll and benefits coordinator. For instance, verification specialist responsibilities require skills such as "customer service," "patients," "insurance verification," and "medicaid." Whereas a payroll and benefits coordinator is skilled in "hris," "human resources," "open enrollment," and "payroll processing." This is part of what separates the two careers.
On average, payroll and benefits coordinators reach similar levels of education than verification specialists. Payroll and benefits coordinators are 3.0% more likely to earn a Master's Degree and 0.1% more likely to graduate with a Doctoral Degree.Verification specialist vs. Benefits representative
A benefits representative is responsible for facilitating and disseminating information about benefits programs and policies across all employees in the company. Benefits representatives respond to the employees' inquiries and concerns of benefits processes, update their benefits information, and resolve discrepancies and disputes. They also support the company's initiatives on developing new benefits plans, implementing campaigns, as well as writing application guides for reference. A benefits representative should have excellent communication and organizational skills as they also conduct surveys to check the efficiency and effectiveness of the benefits programs and adjusting procedures as needed.
Each career also uses different skills, according to real verification specialist resumes. While verification specialist responsibilities can utilize skills like "data entry," "insurance verification," "verification process," and "medical terminology," benefits representatives use skills like "insurance coverage," "term disability," "financial assistance," and "hr."
Benefits representatives may earn a higher salary than verification specialists, but benefits representatives earn the most pay in the finance industry with an average salary of $41,460. On the other hand, verification specialists receive higher pay in the insurance industry, where they earn an average salary of $36,827.Average education levels between the two professions vary. Benefits representatives tend to reach similar levels of education than verification specialists. In fact, they're 2.2% more likely to graduate with a Master's Degree and 0.1% more likely to earn a Doctoral Degree.Verification specialist vs. Benefits & payroll administrator
The Benefits and Payroll Administrator manages the company's payroll, ensuring work benefits and employee documents are secure. The administrator also delivers employees' issues and concerns to the company's proper channels. This position also helps in the audit of the company and ensures compliance with state and federal regulations. This administrative position requires bookkeeping knowledge, a bachelor's degree, and experience in using spreadsheets and accounting software.
There are many key differences between these two careers, including some of the skills required to perform responsibilities within each role. For example, a verification specialist is likely to be skilled in "customer service," "patients," "data entry," and "insurance verification," while a typical benefits & payroll administrator is skilled in "human resources," "hris," "cobra," and "payroll system."
Benefits & payroll administrators earn the best pay in the professional industry, where they command an average salary of $55,595. Verification specialists earn the highest pay from the insurance industry, with an average salary of $36,827.When it comes to education, benefits & payroll administrators tend to earn similar degree levels compared to verification specialists. In fact, they're 2.4% more likely to earn a Master's Degree, and 0.2% more likely to graduate with a Doctoral Degree.Verification specialist vs. Benefits advisor
A benefits advisor specializes in devising benefits programs and strategies for a workforce, ensuring they are well-compensated for their hard work. Typically, their responsibilities revolve around performing research and analysis to identify the needs of employees in a company, studying the benefit programs of competitors, and assessing the existing programs while putting the company's welfare into consideration. They must prepare reports and presentations for clients, provide cost-estimates and business plans, and evaluate risks, all while adhering to the company's policies and regulations, including its vision and mission.
Types of verification specialist
Updated January 8, 2025
