Insurance Specialist Resume Samples

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Insurance Specialists, or Health Insurance Specialists, assist health care providers in organizing their information when it comes to claims or other types of documentation. Skills typically listed on the example resumes of Insurance Specialists include contacting insurance companies to check approval/denial status for medication coverage, and bringing accounts to their final resolutions by resolving patient inquiries. Those interested in pursuing a career as a Health Insurance Specialist should be able to list the completion of a health insurance specialist program on their resumes.

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1

Insurance Specialist, Personal Assistant

Responsible for investment withdrawals, accounts activation, managing client insurance policies, monitoring policy lapses

  • Compiled insurance and investment reports for client meetings
  • Prepared insurance cases for underwriter final approval
  • Managed advisors' state licenses
  • Maintained advisors' compliance with insurance and investment companies
Candidate Info
10
years in
workforce
2
years
at this job
BA
History
2

Social Insurance Specialist

Consulted with beneficiaries about their rights under Social Security, gathered facts and evidence to establish eligibility for benefits, and made critical decisions to determine the amount of benefits paid to individuals initially and continually.

  • Functioned as the claims representative for retirees, widowed, aged, blind, and disabled individuals from diverse educational and socio-economical backgrounds.
  • Developed facts through interviews and correspondence with claimants, lawyers, or advocates for the resolution of discrepancies and to obtain needed information.
  • Processed records in adjudicating or paying claim's, collected documentary evidence for claims or conveyed the requirements that must be met for the receipt of benefit payments.
  • Recommended modifications in procedure or policy and advised management of significant problem areas, resulting in streamlining the application process and improved office function.
  • Identified, investigated, and referred potential program fraud and abuse as necessary.
  • Balanced and prepared the monthly Accountability Report for submission to the Central Office in Baltimore MD.
Candidate Info
21
years in
workforce
21
years
at this job
BS
Business Administration
3

Insurance Specialist

Verified insurance benefits using Passport Health, and Florida Shared.

  • Researched modified unpaid insurance claims and coding discrepancies
  • Implemented a plan of action for patients in need of financial assistance.
  • Performed the daily functions of administrative support, customer service, and cash posting to achieve Patient Financial Services goals of improved collections.
  • Used internal systems such as HBO, and Horizon Clinicals
Candidate Info
18
years in
workforce
7
years
at this job
BA
Health Administration
4

Insurance Specialist

Verified insurance for upcoming surgeries and procedures

  • Problem solved insurance out of pocket issues with patients.
  • Communicated between patients and insurance companies for patients understanding and knowledge of insurance coverage.
  • Problem solved medicare and medicaid issues on a daily basis.
  • Provided assistance with charity applications to approved patients.
  • Processed insurance out of pocket payments after procedures.
Candidate Info
8
years in
workforce
2
years
at this job
Business Administration
5

Insurance Specialist

Set up Bariatric programs in hospitals following specific guidelines set by the insurance industries.

  • Verified insurance benefits and explained to patients individual levels of coverage as well as specific medical criteria.
  • Followed patients throughout the specific pre surgical programs.
  • Typed letters of medical necessity.
  • Conducted peer to peer appeals with medical directors at the insurance companies for denials.
  • Initiated pre authorizations for surgeries and in office procedures.
  • Efficiently managed telephone and in-person inquiries related to billing, insurance, and general information.
Candidate Info
10
years in
workforce
2
years
at this job
6

Insurance Specialist

Secured payment of hospital claims from insurance and workers compensation companies, Medicare and Medicaid, VA and patients

  • Provided persistent, effective and assertive actions in resolving and appealing accounts while maintaining compliance with collections and HIPAA laws
  • Requested UBs, Medical Records, EOBS, and other documents for claims resolution
  • Ensured maximization of collections dollars according to DRG and hospital contracts
Candidate Info
17
years in
workforce
4
years
at this job
BS
Psychology
7

Insurance Specialist

Responsible for completing all duties associated with verification eligibility and authorizations as required for outpatient procedures.

  • Resubmit denied authorization request by appealing and determine reason for denial
  • Verifying insurance coverage by phone and online to ensure proper coordination reimbursement of benefits and estimates of patients' financial responsibilities of commercial, governmental and third party insurances
  • Communicating with doctor's, nurses, receptionist, providers and patients on a daily basis
  • Educating patients regarding insurance benefits and available resources
  • Handling insurance policies with strong knowledge of ICD-9, CPT-10, Medical Terminology and HIPPA regulations.
  • Consistently enter approvals, appeals, benefits and notes using Vitera Intergy EHR Software
Candidate Info
8
years in
workforce
2
years
at this job
HS
Microcomputer Business Systems
HS
High School Diploma
8

Office Manager/insurance Specialist

Responsible for processing and posting all insurance claim using Dentrix software

  • Calculated pretreatment cost estimates and configured any needed payment plan
  • Knowledge about federal, commercial and state dental insurance plans and polices
  • Responsible for keeping all insurance contract fees up to date
  • Completed all doctor's insurance credentialing with insurance companies
  • Corresponding with patients about overdue balances while serving as a liaison to a collection agency
  • Completed referral letters to specials while making proper documentation accompanied any referral
  • Performed patient scheduling for two offices, sent out recall cards and responded to any patient concerns
Candidate Info
29
years in
workforce
18
years
at this job
BS
Early Childhood Education
9

Insurance Specialist

Insurance verification and account setup.

  • Post payments from clients and insurance venders.
  • Increased monthly revenue by 40%.
  • Exceptional ability to prioritize and multitask office duties.
Candidate Info
24
years in
workforce
17
years
at this job
BA
Elementary Education
10

Workers' Compensation Insurance Specialist

  • Assisted health care providers in an attempt to collect unpaid medical bills relating to Workers' Compensation and Commercial insurance
  • Communicated directly with insurance companies for resolution purposes
  • Decision making performed on a daily basis to determine adjustments, appeals, and patient's responsibility
  • Case management and file organization
  • Documented all inquiries from both external and internal customers
  • Organized, prepared and participated in Benefits Review Conferences for the Texas Department of Insurance/Division of Workers' Compensation.
Candidate Info
21
years in
workforce
4
years
at this job
GED
GED

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