Health Insurance Specialist Resume Samples

A Health Insurance Specialist manages a variety of financial factors for patients. Some of the core duties seen on the Health Insurance Specialist Resume indicate the following – reviewing patient records using medical coding procedures; examining the claims and verifying insurance eligibility, recording medical charges and other payment and adjustments; taking responsible for detecting coding errors and performing modifications as needed. Other duties include assisting patients in obtaining and understanding medical benefits; taking responsibility for updating internal databases, billing details and registration forms; and organizing patient records.

The specialists are skillful in many areas of medical billing, insurance, claims and payment processing, medical coding, and medical terminologies; knowledge of computers, data entry, e-mail, and the internet is vital. Strong excellent oral and verbal skills and the ability to multitask are also needed. A health technology-related degree is commonplace among job applicants.

Health Insurance Specialist Resume example

Health Insurance Specialist Resume

Summary : Highly motivated professional with experience in the technology, sales, and insurance industry. Over five years of experience in gathering and interpreting data for billing, reporting, and analysis purposes.

Skills : Microsoft Office Suite; Outlook, SPSS, SAS, Adobe Acrobat, Team Player, Cooperative, Leadership, Multi-Tasking, Detail-Oriented.

Description :

    1. Assisted in the sale and retention of health insurance policies to both individuals and families as well as small and large businesses.
    2. Developed promotional materials and letters.
    3. Assisted with department head special projects and requests.
    4. Assisted in keeping up to date on information for carrier and governmental policies.
    5. Provided exceptional customer service.
    6. Assisted clients with modifications of their plans, medical claims, and pre-approvals.
    7. Emailed correspondence with clients and providers regarding policies.
    8. Responded to customer inquiries and concerns.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
MBA in Marketing


Health Insurance Specialist Resume

Headline : Over 6 years of experience, as a Health Insurance Specialist, seeks to work with a leading medical facility as a health insurance specialist and performing medical coding and filing of medical insurance claims for patients.

Skills : Microsoft Office Suite, Outlook, SPSS, SAS, Adobe Acrobat.

Description :

    1. Greeted customers in a courteous, friendly, and professional manner.
    2. Reviewed insurance policies to determine coverage.
    3. Obtained information from medical reports.
    4. Attached information to claim files.
    5. Transmitted claims for payment or further investigation.
    6. Submitted recommendations to the case supervisor.
    7. Ensured timely and accurate claims payments, and reported denied claims.
    8. Provided necessary information to appeal.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Executive
Education
Education
Diploma in Marketing


Health Insurance Specialist Resume

Summary : A detailed, goal-oriented, health care professional with 10 years of managed care experience, seeking a position with an organization that would provide an opportunity to use office administration and customer service experience.

Skills : Medical Terminology, Customer Service, Marketing, Pharmacy Tech License, Medical Coding.

Description :

    1. Worked in collaboration with the eligibility and enrollment teams to develop/draft/update policies, guidance, regulations, and procedures for the Affordable Care Act.
    2. Reviewed, evaluated, and developed policies/procedures related to private health insurance to ensure compliance with Federal requirements.
    3. Reviewed and analyzed policies and legislation that interpret the rules for the Affordable Care Act.
    4. Interpreted and considered essential data requirements in the Standard Companion Guide and the ASC X12 Benefit Enrollment.
    5. Maintained day-to-day communication and oversight of contractors affiliated with CMS for systems duties related to the Affordable Care Act.
    6. Served as an SME (Subject Matter Expert)to draft written responses for internal and external inquires submitted via email, JIRA, SERTS, Zone, and gap.
    7. Led and participated in meetings with internal and external partners to discuss business needs, developments, systems requirements, legislative updates, and current health care trends.
Years of Experience
Experience
10+ Years
Experience Level
Level
Management
Education
Education
BS in Business Management

Health Insurance Specialist Resume

Summary : Highly qualified Health Insurance Specialist with experience in the industry. Enjoy creative problem solving and getting exposure on multiple projects, and would excel in the collaborative environment on which your company prides itself.

Skills : Microsoft Office, Quickbooks, Typing 50 Wpm, Outlook, Medical Transcription, Medical Billing, Account Management, Account Receivable.

Description :

    1. Handled billing, reviewed and processed Explanations of Benefits (EOBs) from all Insurance carriers for over 350 individual practitioners.
    2. Maintained up-to-date billing procedures & processed for Medicare claims according to CMS guidelines.
    3. Conducted extensive research via the National Government Services database to verify corrective modifiers, payable diagnosis, and CPTs being billed according to CMS regulations.
    4. Prepared financial statements, and posted money transfer.
    5. Prepared refunds to the appropriate insurance carriers.
    6. Identified collection risks for balances.
    7. Initiated and submitted appeals to insurance carriers for reduced or unpaid claims due to the provider's contract.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Diploma In Medical Transcription

Health Insurance Specialist Resume

Headline : To obtain a Health Insurance Specialist position. Retained a friendly and professional demeanor when handing numerous inbound and outbound calls, strategically promoting the company to the potential customer base and providing answers about all products and services. 

Skills : Bilingual, Sales and Marketing, Medical Coding, Interpersonal Skills.

Description :

    1. Provided exceptional customer service by quickly obtaining appropriate quotes and writing various insurance policies.
    2. Retained a friendly and professional demeanor when handing numerous inbound and outbound calls, strategically promoting the company to the potential customer base and providing answers about all products and services.
    3. Properly determined the eligibility of each prospect using CMS (Center for Medicaid and Medicare Services) guidelines as applicable, accurately processing customer requests relating to the programs.
    4. Recognized and strictly complied with all performance standards for work quality, work efficiency, attendance, and schedule adherence.
    5. Productively qualified callers based on specific criteria for a telephonic enrollment, face-to-face in-home appointment, or RSVP to a community meeting hosted by a licensed field sales representative.
    6. Correctly identified numerous policy risks, processed applications, and promptly submitted completed applications to the underwriting staff for review and subsequent approval.
    7. Effectively maintained high sales performance/conversion rate and call quality scores to exceed established client and team goals.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Executive
Education
Education
BS in Business Management

Health Insurance Specialist Resume

Objective : Over 3 years of progressive experience in the Medicare setting with experience managing health plan enrollment, seeking to obtain a customer service or warehouse position in which education and skills can be utilized, in a company that uses the team approach providing excellent customer service.

Skills : Dependable, and Hard Working, Excellent Communication, Filing, Customer Service, Microsoft Office.

Description :

    1. Implemented and interpreted health care policies and effects on consumers.
    2. Analyzed Medicare and Medicaid policies to identify trends in care utilization, and study the private health insurance industry.
    3. Participated in stakeholder meetings regarding the Affordable Care Act implementation.
    4. Provided assistance on outreach strategies for the young and healthy.
    5. Created visual aids for constituent briefings.
    6. Conducted presentations during the Affordable Care Act weekly sharing sessions.
    7. Attended national Affordable Care Act briefings.
    8. Assisted with updating Congressional contacts and creating a Congressional Guide for Region IV.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
MSW in Mental Health

Health Insurance Specialist Resume

Headline : Detail-oriented, organized, and efficient Health Insurance Specialist with over 7 years' experience in an administrative office environment. Educational background includes two years of general and education college courses. 

Skills : Language: Spanish: Basic Reading, and Speaking Computer: Microsoft Office, Excel, Evolve Basic Knowledge CPR/First Aid.

Description :

    1. Verified and reviewed other health insurance policies for veterans, retirees, and dependents of military personnel.
    2. Entered and updated insurance data in specialized military treatment facility software CHCS.
    3. Created Form DD2569s for medical treatment facility patients in the Satellite Pharmacy.
    4. Reviewed electronic medical inpatient records in Essentris software.
    5. Obtained Pre-Certifications from health insurance companies for inpatient encounters.
    6. Verified other health insurance policies using medical billing software TPOCS.
    7. Prepared and presented monthly and quarterly third party data and accounting reports.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Executive
Education
Education
Elementary Education

Health Insurance Specialist Resume

Objective : A highly motivated, results-oriented professional seeking to provide leadership and oversight in a position that maximizes management skills and allows utilization of the experience have gained in quality assurance, project, and operational management, and training experience.

Skills : Excel, Word, Outlook, Customer Service, Training, and Development.

Description :

    1. Performed assignments in Medicare beneficiary outreach, public information, partnership development, and Medicare contractor customer service activities.
    2. Researched and, as needed, consulted with policy staff experts on the issue being addressed.
    3. Participated in the development of the region's customer service and public information plans, develops and maintains relationships with key Medicare partners, and provides recommendations for the outreach efforts.
    4. Provided guidance in developing technical approaches to and maintain liaison with beneficiary organizations, associations, and other customers to enhance the Region's customer service and public relations efforts.
    5. Handled and responded to congressional complaints and issues communicated to CMS on behalf of beneficiaries.
    6. Supported lead attorney and Executive Director and with claims adjudication issues, complex grievances, and appeals.
    7. Supported onboarding and training for health insurance specialists and supported peer and new employee casework.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
MPA in Policy & Administration

Health Insurance Specialist Resume

Objective : Highly qualified and results-driven professional with great ability in communicating and developing relationships with customers. Detail-oriented and highly analytical health law professional with 5 years of combined experience in nursing and law.

Skills : Problem-Solving, Time Management, Interpersonal Skills, Detail Oriented.

Description :

    1. Responsible for delivering general Marketplace information to callers.
    2. Used basic office equipment and technology such as telephones, email, and web browsers to perform the duties.
    3. Assisted the caller with filling out an online application and submitting it electronically to plan providers for processing.
    4. Responded to telephone inquiries within the set departmental staffing and time parameters.
    5. Maintained up-to-date knowledge of CMS regulations and policies as they apply.
    6. Accountable for signing up clients for health insurance through the Marketplace.
    7. Provided education to potential clients and utilized tools specifically designed to select the best coverage based upon each individual's current.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
HS Diploma

Health Insurance Specialist Resume

Objective : Highly organized and detail-oriented professional with extensive experience providing high-quality continuous professional, development, and collaborative quality assurance management in deadline-driven, client-focused healthcare, health insurance, and benefits administration environments.

Skills : Microsoft Office, Organizational, Time-Management, Multi-Tasking, Supervising, Delegating, Communication, Detail Oriented, File Management, Inventory Management.

Description :

    1. Answered a constant flow of customer calls with up to 5 calls in queue per minute.
    2. Addressed and resolved customer product complaints empathetically and professionally.
    3. Gathered and verified all required customer information for tracking purposes.
    4. Effectively managed a high-volume of inbound and outbound customer calls.
    5. Handled all the clerical duties and activities of the organization like- answering phone calls and emails, completing other computer-related activities, communicating with customers to understand their queries and problems.
    6. Received a pack of leads to call and follow up on for the day.
    7. Asked questions over the phone for vital information to help determine eligibility/qualification for health insurance.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
HS Diploma in Nursing