Insurance Specialist Job Description
When it is time to receive medical attention, especially in emergency situations, the average person does not carefully review the details of his health insurance policy. These policies are often composed of complex language with numerous requirements and stipulations. It takes a skilled professional to determine the protocol that identifies a responsible party’s monetary responsibility in a health insurance claim. This is the role of the health insurance specialist.
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Definition
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Health insurance specialists, also referred to as reimbursement specialists or claims examiners, examine health insurance claims to assess whether the provider or the claim holder must pay for medical services that the claim holder received.
Responsibilities
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Specialists answer questions about insurance coverage, process insurance claims and assign billing statements. They must have a firm grasp of the insurance policies specific to an individual provider to properly assess whether the insurance company must reimburse the provider for treatment to a patient.
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Qualifications
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The position requires wide-ranging skills to examine different insurance issues. General qualifications include computer, communications, analytical and comprehension skills. Specialists should understand terminology used in medical or dental billing and have computer proficiency, according to the Tennessee Technology Center at Nashville.
Education
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At least a high school diploma is necessary, but applicants with college degrees may receive preference. College courses or specialized programs that emphasize science, medical terminology, medical insurance practices, dental insurance practices and computers will give the core knowledge required to become a health insurance specialist. English or communications courses will also provide proficiency in written and oral communication.
Salary
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Health insurance specialists earned an average annual salary of $70,000, as of July 2010, according to Indeed.com. Salaries may vary depending on the specific field, which ranges from insurance sales to medical billing, according to Education-Portal.com. The responsibilities required of a specialist within a specific industry can determine the starting salary, rate of promotion and bonuses.
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