Insurance Specialist Job Description

Insurance Specialist Job Description

175 votes for Insurance Specialist
Insurance specialist provides data to third party organizations including State and County Courts, Federal and State Tax Authorities.

Insurance Specialist Duties & Responsibilities

To write an effective insurance specialist job description, begin by listing detailed duties, responsibilities and expectations. We have included insurance specialist job description templates that you can modify and use.

Sample responsibilities for this position include:

Close un-pursuable cases within 2 business days after being instructed by the State (Wyoming Department of Health)
Open subrogation cases according to Operational Procedures
Work open active subrogation cases according to Operational Procedures every week, every 30 days, or every 60 days depending upon case type until subrogation cases are resolved
Close cases within 1 business day when returned by the Attorney General’s Office
Update the TPL Resource File with health insurance information
Performs insurance prescreening and verification of benefits
Provide prior authorization assistance claims assistance, including billing and coding instructions, to physicians and/or office staff
Daily additions of charges, either new charges or replacement charges and the workflow based on if the claim has submitted
Provide technical training and direction for branch product processing in the area of insurance
Responsible for gathering of all client renewal information, creation of renewal documents, carrier confirmations, review and follow up regarding submissions, endorsements, declinations, policy issuance, extensions and cancellations and escalating concerns to direct manager or Client Team, as appropriate Manages and records all confirmation and follow up activities in workflow system

Insurance Specialist Qualifications

Qualifications for a job description may include education, certification, and experience.

Licensing or Certifications for Insurance Specialist

List any licenses or certifications required by the position: RM, CLU, ID, ARM, CFP, AFP/AFC

Education for Insurance Specialist

Typically a job would require a certain level of education.

Employers hiring for the insurance specialist job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Collage Degree in Education, Business, Associates, Finance, Accounting, Medical, Graduate, Graduate Education, General Education, Management

Skills for Insurance Specialist

Desired skills for insurance specialist include:

State & federal collections guidelines
Third party claims processing
Administrative procedures
Windows based programs and basic data entry skills
Privacy Act
Profession and industry

Desired experience for insurance specialist includes:

2+ years of healthcare related reimbursement experience
Spanish speaker strongly preferred
Evaluate and investigate appropriate action to be taken in order to reconcile the receivable in accordance with department goals
Knowledge of internal computer systems necessary to manage receivables (Utilize Excellian and various systems and demonstrate understanding of procedures for registration/verification modules, Claims Processing system, Web based provider systems,etc., if applicable to position)
Communication and feedback (Help train and mentor other team members on the specific nuances of each Payer, to insure compliance to the processes established
Resolve issues with front-end edit errors using multiple systems including Xifin, Excellian, Ultra, and payor websites

Insurance Specialist Examples


Insurance Specialist Job Description

Job Description Example
Our innovative and growing company is hiring for an insurance specialist. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for insurance specialist
  • Maintain current manual environment until policies have been moved to vendor system
  • AKF IS serve as a Liaison to the American Kidney Fund’s Health Insurance Premium Program (HIPP)
  • Proactively contact carriers regarding reduced or denied reimbursement and ensure patient insurance information is accurate
  • Develop, submit and track appeals to carriers, per department procedure
  • Review and analyze all incoming explanation of benefits
  • Adjust patient' accounts to reflect the carrier decisions on the patient's statement
  • Oversee a specialized group of accounts within the Insurance Department and handle all accounts that have a property damage claim against the vehicle
  • Handles a specialized group of accounts within the Insurance Department to process all paperwork necessary to complete GAP claims for consumers that have purchased supplemental GAP Insurance with their vehicles
  • Work a route of accounts to settle insurance claims
  • Take inbound and make outbound calls using the Artiva Call flow
Qualifications for insurance specialist
  • Must have knowledge of various types of insurance coverage available
  • Must understand policy requirements for underwriting purposes such as policy coverage clauses, loss payee and mortgage information, limits of liability
  • Work experience in bancassurance sales is highly preferred for this position but those with sales and customer service experience gained from banking, transport, pharmaceutical, FMCG, hospitality and IT industries are also encouraged to apply Must be self-driven and highly motivated
  • Two (2) years' experience insurance coverage verification/benefit determination
  • Provide back-up support in the absence of receptionist (during lunch hour, absences due to illness, vacation, or as needed on other occasions)
  • 3-5 years of work experience required, with 3+ years previous insurance or financial services experience preferred

Insurance Specialist Job Description

Job Description Example
Our company is growing rapidly and is searching for experienced candidates for the position of insurance specialist. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for insurance specialist
  • Fill out necessary paperwork pertaining to insurance claims
  • Assist in gathering documents for Protective GAP Claims
  • Communicate with cross functional departments in settling claims
  • Collect on past due balances while insurance claims are pending
  • Process necessary paperwork pertaining to GAP Claims
  • Calculate NY GAP adjustments
  • Insurance claims need to be settled as quickly as possible
  • Responsible for settling claims compliantly
  • Call Evaluations will be conducted throughout the month and measured via NPS Score
  • Evaluate eligibility of financial assistance requests and applications that are received in Adobe format
Qualifications for insurance specialist
  • Experience with enrollment/Medicare
  • High speed and accuracy with regards to Alpha-Numeric data entry
  • Medical or health insurance experience
  • Go to
  • Create and account
  • Ensure that you "uplink" a "word-formatted" resume with your past work experience

Insurance Specialist Job Description

Job Description Example
Our growing company is hiring for an insurance specialist. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for insurance specialist
  • Communicate status and outcome to Social Worker
  • Record requests in internal database for tracking
  • Ensure timely processing for prompt turnaround time of urgent requests to ensure financial assistance needs are submitted for patient insurance continuation
  • Generate grant requests in web-based systems used by qualified charities
  • Ensure accuracy to avoid returned requests
  • Research returned requests and/or premium checks/refunds
  • Contact health insurance companies to verify premium payment and premium rates
  • Respond to telephone calls and emails regarding request process, requirements, and status of applications
  • Review, update and submit department reports
  • Scan, file, and purge records as needed
Qualifications for insurance specialist
  • Basic accounts payable experience preferred
  • Intermediate Microsoft Office proficiency TBD
  • The Insurance Specialist is responsible for providing life insurance solutions to clients
  • Work experience in sales is highly preferred for this position but those with sales and customer service experience gained from banking, transport, pharmaceutical, FMCG, hospitality and IT industries are also encouraged to apply Must be self-driven and highly motivated
  • Minimum two-years broad based property and casualty insurance or related experience
  • Knowledge of various types of commercial property insurance policies

Insurance Specialist Job Description

Job Description Example
Our innovative and growing company is looking for an insurance specialist. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for insurance specialist
  • Gather and document a detailed and comprehensive understanding of the various insurance plans and benefits for the different payor classes (State Medicaid, Commercial insurance and Medicare Part D plans) and being able to effectively communicate the therapy(s) and coverage requirements to the Payor sources
  • The Insurance Specialist is responsible for the accurate and responsive intake of new patient referrals from the Sales Staff, the referring practice professionals or Patient Information Coordinators
  • Request authorization and verification of medical and pharmacy benefits for specialty medications
  • You pursued a career in health science to fuel your quest for knowledge and your desire to make the world a better place
  • Candidates need to be available for all after-training shifts 9am-6pm, 10am-7pm, and 11am-8pm (will be assigned to one shift, and that will be their shift ongoing) - Mon through Fri
  • Insurance Specialist assists organization with commercial and self-insurance programs
  • Insurance Specialist assists with the management of claims and maintaining reports as needed
  • Insurance Specialist reviews and negotiates contracts to ensure proper insurance provisions
  • Responsible for resolving employee questions and issues through interpretation of policies and procedures
  • Reviews reports, researches and resolves issues pertaining to insurance denials
Qualifications for insurance specialist
  • Basic understanding of health insurance and insurance verification experience preferred
  • Insurance policy review experience
  • Loan servicing experience insurance agency or insurance carrier work experience is preferred
  • 4 years insurance verification and/or pre-certification experience required
  • Must have at least 1 year of medical claims resolution/follow-up OR vocational school certification in Medical Insurance and Billing
  • Bachelor’s Degree or at least 4 yrs of equivalent work experience

Insurance Specialist Job Description

Job Description Example
Our company is looking for an insurance specialist. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for insurance specialist
  • Assists in research in order to accurately report refunds
  • Manage JELD-WEN’s incoming certificate tracking program (maintain provider database, request updated or missing insurance information, index and scan certificates)
  • Assist with policy file set up, policy database entry, scanning
  • Provide administrative and clerical support to the insurance department
  • Make efficient use of work time to accomplish assignments and expected outputs the ability to accept or respond to change in the work environment in a way that promotes department goals and objectives, to include notifying Team Leader when able to do additional work
  • Provide coverage as needed to include performing other related duties as required, which may include but not limited to scheduling and registration and participate as a preceptor in the training of co-workers
  • As necessary, the Patient Access Representative II may also perform quality audits and negotiate pricing
  • Will contact insurance payers to verify patient eligibility and drug benefits within required time frames to ensure services provided will be reimbursable
  • Will obtains Prior Authorizations from payers
  • Intake new patient referrals from the sales staff, practice professionals, or Patient Information Coordinators
Qualifications for insurance specialist
  • Previous experience with an Electronic Health Record and documentation
  • 1 year free from chemical abuse problems
  • Demonstrated ability to communicate and maintain positive interpersonal relationships within a diverse community
  • Dental terminology
  • Experience that reflects familiarity with PPO/EPO, Medicaid and the American Dental Association (ADA) Code on Dental Procedures and Nomenclature
  • Knowledge of and adherence to company policies and protocols

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