INSURANCE VERIFICATION SPECIALIST SKILLS, EXPERIENCE, AND JOB REQUIREMENTS

Published: Sep 30, 2025 - The Insurance Verification Specialist has experience in understanding insurance benefits, including deductibles, co-insurance, exclusions, out-of-pocket expenses, and navigating benefit structures. This role requires strong communication and organizational skills, proficiency in EMR systems, task prioritization, and familiarity with platforms such as Navinet, One Source, Availity, and major insurers like Cigna, United Healthcare, Geico, Tricare, and AARP. The specialist is also detail-oriented, dependable, adaptable to various tasks, and capable of providing quality customer service while working independently or in a team within a deadline-driven environment.

Essential Hard and Soft Skills for a Standout Insurance Verification Specialist Resume
  • Insurance Verification
  • Eligibility Verification
  • Authorization Processing
  • Benefit Verification
  • Data Entry
  • Medical Terminology
  • Coverage Verification
  • Claims Management
  • Document Management
  • Confidentiality Compliance
  • Customer Service
  • Effective Communication
  • Critical Thinking
  • Team Collaboration
  • Problem Solving
  • Patient Communication
  • Attention To Detail
  • Issue Resolution
  • Time Management
  • Adaptability

Summary of Insurance Verification Specialist Knowledge and Qualifications on Resume

1. BA in Business Administration with 3 years of Experience

  • Excellent oral, written, and listening communication skills.
  • Effective organization and time management skills.
  • Ability to manage multiple tasks simultaneously and work in high-pressure situations.
  • Excellent interpersonal skills and demeanor.
  • Proficient in the use of a PC, in a Windows environment, in the use of the Internet, and in the use of MS Office Applications such as Outlook, Word and Excel.
  • Proficient in the use of eMR systems such as Aprima.
  • Ability to adhere to strict attendance and punctuality expectations.
  • Ability to attend to details, ensuring accuracy in a timely manner.
  • Ability to work both independently and collaboratively.
  • Ability to identify and proactively solve problems.
  • Ability to thrive in a patient-focused environment.
  • Ability to demonstrate Pain Doctor’s core values and performance principles of leadership, integrity, kindness, excellence, and service.

2. BA in Communication Studies with 2 years of Experience

  • Must have experience working with insurance companies.
  • Extensive knowledge of different types of coverage and policies.
  • Must have excellent multitasking skills, with the ability to work on many projects at once.
  • Must be very detail-oriented and organized to maintain accurate patient insurance records.
  • Ability to focus and work quickly, as insurance paperwork commonly needs to be processed in a timely manner.
  • Must work well with others, work as part of a health care team, striving to provide patients with the best care possible.
  • Must display exceptional verbal and written communication, interpersonal and active-listening skills.
  • Ability to prioritize issues and respond accordingly.
  • Able to manage multiple scenarios and expectations in a fast-paced environment.
  • Must have an incredibly detail-oriented person, and can display empathy and care for clients.
  • Able to identify and assess customers' needs to achieve satisfaction.
  • Able to have a fun and upbeat attitude and love working with people.
  • Able to be open-minded to learn new techniques.

3. BA in Health Administration with 4 years of Experience

  • Experience in a health plan, facility, healthcare provider office, or pharmaceutical industry.
  • Working knowledge of reimbursement (i.e., benefit investigation, prior authorization, pre-certification, letters of medical necessity).
  • Knowledge of Medical Terminology.
  • Working knowledge of drug reimbursement issues.
  • Understanding of Health Plan Medical Policies and Prior Authorization Criteria.
  • Knowledge of HCPCS, CPT and ICD-10 coding.
  • Must have data entry skills.
  • Ability to resolve problems independently.
  • Ability to follow instructions.
  • Adaptable to changing priorities.
  • Ability to manage multiple priorities concurrently.

4. BS in Nursing with 3 years of Experience

  • Ability to type at least 40-45 words per minute.
  • Must have accurate data entry skills and be detail-oriented.
  • Must have a computer and research skills.
  • Extensive knowledge of insurance type coverage and policies.
  • Knowledge of Revenue Cycle.
  • Ability to work on multiple tasks at once.
  • Able to work well in a team environment.
  • Ability to communicate well with the public and other personnel in a professional and courteous manner.
  • Experience in insurance verification.

5. BS in Public Health with 5 years of Experience

  • Insurance verification, authorization and/or contracting experience in Home Health or related industry (Hospice, Hospital, Physician, etc.).
  • Experience with Medicare, Medicaid and Private Insurance billing/collections.
  • Must have a strong work ethic.
  • Well organized and a self-starter.
  • Must be able to follow standard filing procedures.
  • Detail-oriented, professional attitude, reliable.
  • Proficient in Excel and Word, 10-key by touch.
  • Possess strong organizational and time management skills, as well as problem-solving skills.
  • Basic accounting principles knowledge, documentation skills, research and resolution skills, data analysis and multi-tasking skills.
  • Ability to interact with others in a professional manner.
  • Ability to work independently and with a team in a fast-paced and high-volume environment with emphasis on accuracy and timeliness.
  • Ability to handle confidential information in a discreet, professional manner.
  • Ability to eye for detail, accuracy, and meet deadlines.
  • Excellent oral and written communication, organizational, and analytical skills.
  • Ability to be an effective team member and display initiative.

6. BS in Health Information Management with 4 years of Experience

  • Understanding and effective use of basic principles of administration in a healthcare environment.
  • Equivalent job-related health care experience.
  • Experience in using electronic health record software, eligibility and electronic billing.
  • Strong computer skills, including proficiency in using EHR, SPOT, Availity, Navinet and other payer sites.
  • Exceptional communication skills- both written and verbal.
  • Ability to read, understand, and adhere to CMS guidelines and compliance.
  • Superior organizational skill, attention to detail.
  • Ability to work without micro-management.

7. BA in Psychology with 2 years of Experience

  • Healthcare or customer service experience.
  • Must have the ability to consistently meet performance standards of production, accuracy, completeness, and quality.
  • Ability to understand and adhere to payer guidelines by plan and service type.
  • Good listening, interpersonal and communication skills, and professional, pleasant and respectful telephone etiquette.
  • Able to exhibit high-quality work and use excellent judgment.
  • Able to communicate clearly.
  • Able to take the initiative to identify and resolve issues.
  • Willingness to learn and take on new tasks.
  • Able to demonstrate resourcefulness and cooperation.
  • Able to exhibit BI’s core values in all interactions.

8. BS in Biology with 3 years of Experience

  • Strong understanding of benefits, investigating, deductibles, co-insurance, out-of-pocket expenses and benefits exclusions.
  • Excellent communication and organizational skills.
  • Excellent communication skills.
  • Ability to work independently and as part of a team.
  • Willingness to take on new/various tasks assigned.
  • Able to be detail-oriented.
  • Strong TASK prioritization skills.
  • Ability to utilize the computer for 6-8 hours daily.
  • Proficient in keyboarding/computer use, including knowledge of EMR systems.
  • Able to provide quality customer service by being available for scheduled shifts, including arriving promptly and completing demands for the daily scheduled workload.
  • Ability to effectively handle multiple responsibilities simultaneously in a deadline-driven environment.
  • Experience working with Navinet, One Source, Cigna, United Health Care, Geico, Availity, Tricare and AARP, along with other pertinent insurance carriers.

9. BA in Sociology with 2 years of Experience

  • Excellent oral and written communication skills.
  • Excellent organizational and analytical skills.
  • Must have excellent computer skills.
  • Basic PC skills, including PC based applications (MS Word, Excel).
  • Ability to learn new software quickly.
  • Must have mathematical aptitude.
  • Excellent guest relations for all internal and external customers.
  • Member Services experience in the Healthcare industry.
  • Computer-literate and can quickly navigate in a Windows PC environment.
  • Must be bilingual (English and Spanish).
  • Strong understanding of health plan terminology.

10. BS in Healthcare Administration with 3 years of Experience

  • Must have exceptional verbal and written communication skills.
  • Ability to articulate care plans to payors of treatment services.
  • Must have critical thinking and problem-solving skills.
  • Knowledge and understanding of the American Society of Addiction Medicine (ASAM) criteria.
  • Experience in insurance verification.
  • Demonstrated track record of strong written and verbal communication skills.
  • Knowledgeable about medical terminology, insurance products and plans.
  • Previous experience working with a healthcare practice management system.
  • Experience with Microsoft Office.

11. BA in Human Resources Management with 2 years of Experience

  • Strong problem-solving and analytical skills.
  • Experience in healthcare, insurance verification, or authorization experience.
  • Must have a positive attitude and an engaging businesslike approach.
  • Ability to work in a fast-paced environment.
  • Ability to use multiple computer systems, applications, and utilize search tools to find information.
  • Excellent verbal, written, and social communication skills.
  • Must have insurance experience.
  • Able to be oriented.
  • Must have computer skills.
  • Must have previous EMR experience.
  • Ability to work independently and as a team.

12. BS in Medical Technology with 4 years of Experience

  • Working knowledge of Managed Care contracts and how they work.
  • Ability to verbalize the knowledge of Managed Care Contracts.
  • Working knowledge of manually calculating insurance allowed amounts and patient responsibility.
  • Working knowledge and comprehension of EOB’s (Explanation of Benefits).
  • Ability to effectively present information to patients, physicians, and other employees of the surgery center.
  • Must have basic math skills.
  • Ability to operate computers, computer software, and multi-line telephones.
  • Ability to work in a team setting by assisting team members and sharing knowledge.
  • Must be well-organized and detail-oriented.
  • Finance and/or billing experience, preferably in a medical practice, payer, or hospital setting, especially experience with commercial insurance.

13. BA in Social Work with 5 years of Experience

  • Knowledge of medical terminology and billing background.
  • Work experience that can be demonstrated to apply to the duties listed in the job description.
  • Working knowledge of Microsoft Office Software.
  • Understanding of CPT codes and ICD-10 numbers.
  • Ability to type 40 WPM.
  • Must have healthcare experience.
  • Proficient in Microsoft Word and Excel.
  • Able to comply with hospital policies.
  • Must be bilingual in Spanish.
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