How to Be Health Insurance Specialist - Job Description, Skills, and Interview Questions

Apr 4, 2020 / 5 Minutes Read / By Albert

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The rising cost of healthcare has caused an increase in demand for health insurance specialists. These professionals are tasked with helping individuals and businesses understand their health insurance options and ensure they get the best coverage for their needs. As a result, these experts are highly sought after in the health insurance industry as they can help people navigate the complex and often confusing world of health insurance.

Health insurance specialists also have the skills to help individuals and businesses choose a plan that meets their needs while also minimizing their financial risks. With the right knowledge and expertise, they can help individuals and businesses make the best coverage decisions.

Steps How to Become

Obtain a High School Diploma or GED. Most health insurance specialist positions require a high school diploma or equivalent.
Pursue Postsecondary Education. Many employers prefer to hire health insurance specialists who have completed a certificate or associate degree program in health insurance, medical billing and coding, or a related field.
Gain Hands-On Experience. Many companies prefer to hire health insurance specialists who have prior experience in the field. Internships and volunteer opportunities are a great way to gain the necessary experience.
Become Certified. Obtaining a certification in health insurance can demonstrate mastery and knowledge of the field and help applicants stand out from the competition.
Pursue Continuing Education. Health insurance regulations and policies are constantly changing, so health insurance specialists must stay up-to-date on these changes. Continuing education courses are often required to maintain certifications and licensure.

The healthcare industry is an ever-changing field that requires professionals to stay up-to-date with the latest industry trends and regulations. To become a successful health insurance specialist, it is essential to have a thorough understanding of the health insurance industry, be knowledgeable on health insurance laws and policies, and possess strong interpersonal and communication skills. Having a formal degree in the field of healthcare, such as a Bachelor's of Science in Health Insurance Management, can provide a solid foundation for a career as a health insurance specialist.

It is also important to stay abreast of new technology and advances in the insurance industry, as well as gain experience through internships or entry-level positions. Through hard work, dedication, and a commitment to learning, a health insurance specialist can become a valuable asset to any healthcare organization.

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Job Description

Analyze and evaluate health insurance policies to ensure they comply with applicable laws and regulations.
Prepare and maintain detailed records of customer information and policy information.
Calculate premiums, benefits, and other costs associated with health insurance policies.
Develop and implement strategies to market health insurance policies to potential customers.
Answer customer questions about health insurance policies, coverage, and costs.
Counsel customers on health insurance options and available alternatives.
Negotiate with insurance providers to obtain the best possible pricing for customers.
Ensure that customer claims are processed in a timely manner.
Work with providers to identify and resolve any discrepancies regarding customer claims.
Monitor changing laws, regulations, and industry trends related to health insurance.

Skills and Competencies to Have

Knowledge of health insurance policies, regulations, and procedures.
Excellent organizational and communication skills.
Ability to work in a fast-paced environment.
Proficiency in utilizing computer software and databases.
Ability to handle multiple tasks simultaneously and prioritize workload.
Strong problem-solving and analytical skills.
Attention to detail and accuracy.
Understanding of customer service principles and practices.
Ability to assess customer needs and provide appropriate solutions.
Ability to work with a high degree of accuracy and confidentiality.

Having a good knowledge of health insurance is essential for any health insurance specialist. The importance of being an effective health insurance specialist lies in the ability to understand the different types of insurance plans, the regulations and laws governing them, and the ability to communicate effectively with both individual clients and insurance companies. A health insurance specialist must be knowledgeable in the different policies and plans available in the market, as well as the deductibles and co-pays associated with them.

They must also be able to assess a client's needs and create a customized plan that meets those needs. Furthermore, they need to be able to explain the options to the clients in a clear and concise manner and be able to provide guidance regarding the best policy for their individual needs. In addition, they need to be able to handle claims processing, customer service inquiries, and other administrative tasks.

All these skills are needed in order to be an effective health insurance specialist and ensure that clients receive the best coverage possible.

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Frequent Interview Questions

What experience do you have working in health insurance?
What specific skills do you bring to this role?
How do you stay current on the latest trends in health insurance?
How do you handle customer complaints and inquiries?
What strategies do you use to ensure customer satisfaction?
How do you ensure accuracy and completeness of health insurance applications?
Describe a situation in which you had to resolve a dispute regarding a health insurance policy.
How do you prioritize tasks when dealing with multiple customer requests?
Explain your experience dealing with difficult clients or sensitive information.
What challenges have you faced in the past related to health insurance?

Common Tools in Industry

Medical Billing Software. This software assists insurance specialists in organizing and tracking medical billing information. (eg: Kareo Medical Billing Software)
Claims Processing System. This system helps process claims and facilitates communication between insurance companies and healthcare providers. (eg: InstaMed Claims Processing System)
Health Insurance Database. This database stores information about health insurance plans and their benefits, allowing specialists to quickly access important information when needed. (eg: MIB Health Insurance Database)
Patient Portal. This portal allows patients to access their medical records and other information related to their insurance coverage. (eg: MyChart Patient Portal)
Compliance Software. This software helps ensure that a company's policies and procedures are in line with government regulations and standards. (eg: Panorama Compliance Software)

Professional Organizations to Know

American Association of Health Insurance Plans (AAHIP)
National Association of Insurance Commissioners (NAIC)
American Academy of Actuaries (AAA)
Health Insurance Association of America (HIAA)
Society of Actuaries (SOA)
National Association of Health Underwriters (NAHU)
The Alliance of Health Insurance Agents (AHIA)
National Association of Insurance and Financial Advisors (NAIFA)
Council for Affordable Health Coverage (CAHC)
The National Association of Professional Benefit Administrators (NAPBA)

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Common Important Terms

Premium. A pre-determined amount of money that must be paid in order to maintain health insurance coverage.
Deductible. The amount of money that must be paid out-of-pocket before health insurance coverage begins.
Co-insurance. The percentage of medical expenses that a health insurance plan requires the policyholder to pay.
Co-payment. A fixed dollar amount that an individual must pay for a specific service or prescription drug.
Out-of-pocket Maximum. The maximum amount an individual is responsible for paying in a year for covered medical expenses.
Provider Network. A list of health care providers who have agreed to accept a particular health insurance plan's terms and conditions.
Claim. A request for reimbursement of a medical expense by a policyholder.
Benefit Summary. A document that outlines the specific benefits and coverage of a health insurance plan.
Explanation of Benefits. A document that outlines the details of a medical claim and the health insurance plan's payment for the claim.
Pre-authorization. A process through which a health insurance plan must approve certain services or treatments prior to them being provided.

Frequently Asked Questions

What qualifications are required to become a Health Insurance Specialist?

To become a Health Insurance Specialist, you typically need a high school diploma or equivalent and experience in a healthcare field. In some cases, you may need additional certification or a college degree.

What tasks do Health Insurance Specialists typically perform?

Health Insurance Specialists help people understand their health insurance benefits, assist with filing claims and appeals, and provide assistance with billing and enrollment. They may also review medical records, help people select plans, and answer questions related to health insurance.

What is the average salary for a Health Insurance Specialist?

According to the U.S. Bureau of Labor Statistics (BLS), the median annual salary for Health Insurance Specialists is $45,660. Salaries vary based on experience, location and other factors.

What type of environment do Health Insurance Specialists typically work in?

Health Insurance Specialists typically work in office settings, such as hospitals, insurance companies, or healthcare organizations. Some may also work remotely from home.

What are some of the benefits of working as a Health Insurance Specialist?

Working as a Health Insurance Specialist can provide job growth and stability, a flexible work schedule, and the satisfaction of helping people understand their healthcare coverage. Additionally, many employers offer health insurance and other benefits.