Health Insurance Specialist: Job Description and Requirements

Sep 10, 2019

A health insurance specialist manages a number of financial factors for patients. These specialists often must have prior experience in health insurance in addition to computer and communication skills. Schools offer programs for prospective health insurance specialists, which may be required.

Essential Information

Health insurance specialists are responsible for processing medical insurance claims, medical coding, and maintaining patient records in various health care settings. Job titles for insurance specialists include insurance billers, medical coders, and claims examiners. Prospective candidates should have previous experience and may wish to complete an educational program for health insurance specialists, as well as an optional certification for coding.

Required Education Completion of a health insurance specialist program
Other Requirements Previous work experience in the health insurance field, strong computer and communication skills
Certification Optional Certified Professional Coder (CPC) credential is available
Projected Job Growth (2018-2028)* 11% for all medical records and health information technicians
Median Annual Salary (2018)* $40,350 for all medical records and health information technicians

Source: *U.S. Bureau of Labor Statistics

Health Insurance Specialist Job Description

Health insurance specialists carry many different responsibilities, which include reviewing patient records using medical coding procedures. They examine the claims and verify insurance eligibility, as well as record any medical charges and other payments or adjustments. Health insurance specialists are also responsible for detecting any coding errors or performing any modifications needed.

Other responsibilities include assisting patients in obtaining and understanding medical benefits. In the office, communication with other medical staff members and health insurance providers often occur. They are also responsible for updating any internal databases, which electronically store and organize patients' records, billing details, and registration forms

Requirements for Health Insurance Specialists

Health insurance specialists are generally skilled in many areas of medical billing, including claims and payment processing, medical coding, and medical terminology. Knowledge of computers, data entry, e-mail, and the Internet is essential. Health insurance specialists may also need excellent oral and verbal skills, as well as the ability to multi-task and assign priority levels.

Employers typically require previous experience in the health insurance sector. Most employers also prefer completion of an educational program. Future health insurance specialists can gain experience and formal academic training by completing a health insurance specialist program. Programs are offered at most community colleges, technical schools, universities, or other business colleges. Courses may include office procedures, medical coding, medical terminology, and principals.

Though not required, health insurance specialists may obtain a Certified Professional Coder (CPC) certification through the American Academy of Professional Coders ( To take the certification examination, candidates must possess a minimum of two years prior work experience and pass a written examination, which covers areas such as anatomy, anesthesia, digestive, laboratory, pathology, respiratory, and urinary.

Salary Info and Job Outlook

The U.S. Bureau of Labor Statistics (BLS) categorizes health insurance specialists as one type of medical records and health information technician. In May 2018, the BLS reported the median annual salary earned by such technicians as $40,350. The employment of health information technicians is projected to grow by approximately 11% between 2018 and 2028, per the BLS, which is much faster than the average for all occupations.

Handling insurance claims, medical coding, and other financial business are the responsibility of a health insurance specialist. Employers prefer they have formal training, which can be attained through college coursework; experience is also essential. Professional certification is another extra credential.

Next: View Schools
Created with Sketch. Link to this page

Popular Schools

The listings below may include sponsored content but are popular choices among our users.

Find your perfect school

What is your highest level of education?