WHAT DOES AN INSURANCE SPECIALIST DO?

Published: Sep 29, 2025 - The Insurance Specialist understands the unique financial needs of customers and provides tailored advice on complex Life and Health Insurance products and services. This role involves deepening customer relationships through active listening, thoughtful questioning, and delivering exceptional service while ensuring compliance with regulatory standards. The specialist also contributes to business growth by taking ownership of results, innovating to simplify processes, and supporting both personal and team development within a diverse and collaborative environment.

A Review of Professional Skills and Functions for Insurance Specialist

1. Insurance Specialist Details and Accountabilities

  • Tenant Communication: Correspond with tenants in response to their requests, notifications received, and outstanding items.
  • Insurance Collaboration: Collaborate with outsourced insurance review and advisory teams and internal departments.
  • Legal Correspondence: Correspond with outside legal counsel regarding reviewing legal documents.
  • Department Interaction: Interact with other internal departments on tenant and property matters.
  • Database Management: Update the property database regarding property matters.
  • Request Handling: Responsible for handling general requests.
  • Document Handling: Responsible for handling document requests.
  • Insurance Assistance: Assist with insurance matters.
  • Coverage Support: Assist with force-placed coverage.
  • Coverage Database: Maintain a database for company-maintained property coverages.
  • Third-Party Support: Assist with requests from third parties.
  • File Organization: Assist with electronic file organization.
  • Culture Development: Consciously create a workplace culture that is consistent with STORE’s mission, vision, and guiding values.

2. Insurance Specialist Job Description

  • Appointment Scheduling: Schedule appointments with warm leads.
  • Continuous Training: Attend consistent and ongoing training via in-person and webinars.
  • Policy Sales: Present and sell insurance policies to new and existing clients.
  • Plan Development: Develop and calculate suitable plans based on clients' needs.
  • Business Networking: Expand business reach through networking techniques.
  • Regulatory Compliance: Comply with insurance standards and regulations.
  • Performance Tracking: Track and identify areas for improvement.
  • Work-Life Balance: Emphasis on work/life balance.

3. Insurance Specialist Overview

  • Policy Management: Ensure that insurance coverage policies of secured consumer loan products are updated and insurance premiums are paid on time.
  • Renewal Processing: Ensure that insurance renewal notices, letters of advice, and billing letters of insurance coverage are sent to and received by the client.
  • Client Support: Respond to clients’ requests and queries regarding insurance coverage within a reasonable turnaround time.
  • Customer Satisfaction: Ensure minimal to zero complaints are received from clients.
  • Payment Reconciliation: Reconcile insurance premium payments pertaining to new and renewed policies.
  • Premium Collection: Collect directly from the client the unpaid insurance premium.
  • Collections Handling: Endorse account to external collection agency/ies.
  • Bank Coordination: Coordinate with various units of the bank regarding insurance coverage.

4. Insurance Specialist Duties

  • Claims Processing: Process and file physical damage, total loss, and GAP claims with insurance agencies and other third-party administrators.
  • Guarantee Issuance: Issue letters of guarantee for assets declared as a total loss.
  • Status Monitoring: Maintain communication to monitor claim status.
  • Claims Negotiation: Negotiate claim resolutions with insurance agencies and/or other third-party administrators to maximize recovery and minimize company losses.
  • Damage Assessment: Obtain vehicle inspection reports or appraisals to assess physical damage, repair estimates, and/or total loss or diminished values.
  • Claims Filing: File claims with insurance companies and/or other applicable third-party administrators.
  • Documentation Research: Conduct research and submit required documentation to GAP insurance agencies and/or third-party administrators.
  • Account Review: Review and monitor accounts daily, ensuring proper and accurate documentation of all account activities.
  • Loan Monitoring: Monitor loans for monies to post accurately on Insurance and GAP claims.
  • Customer Contact: Initiate contact with customers to satisfy deficient balances and respond to information requests.
  • Issue Resolution: Research and resolve issues.
  • Regulatory Compliance: Ensure compliance with Exeter’s policies and procedures, as well as state and federal laws, regulations, and standards.

5. Insurance Specialist Details

  • Customer Focus: Champion a customer-focused culture to deepen client relationships and leverage broader Bank relationships, systems, and knowledge.
  • Administrative Support: Provide administrative and processing support for workload management and prioritization of creditor insurance across the product scope.
  • Inquiry Resolution: Investigate and resolve inquiries in a timely manner for internal and external partners.
  • Process Management: Maintain the quality and efficiency of the unit’s processing by ensuring daily work is monitored, prioritized, and completed with a high degree of accuracy.
  • Risk Awareness: Understand how the Bank’s risk appetite and risk culture should be considered in day-to-day activities and decisions.
  • Operational Excellence: Actively pursue effective and efficient operations in alignment with Scotiabank’s Values, Code of Conduct, and Global Sales Principles.
  • Business Controls: Ensure the adequacy, adherence to, and effectiveness of day-to-day business controls.
  • Regulatory Compliance: Meet obligations with respect to operational, compliance, AML/ATF/sanctions, and conduct risk.
  • Performance Culture: Champion a high-performance environment and contribute to an inclusive work environment.

6. Insurance Specialist Responsibilities

  • Contract Administration: Conclude insurance, administer and service insurance contracts, including registration and payment in the information system.
  • International Correspondence: Responsible for correspondence between the company and partners in foreign markets.
  • Report Preparation: Prepare the necessary references and reports.
  • Inquiry Handling: Respond to inquiries, prepare offers, and determine tariff numbers.
  • Client Consultation: Provide consultations to clients by phone, assess their needs for specific services, and present solutions.
  • Premium Calculation: Determine insurance amounts and premiums.
  • Client Presentations: Participate in presentations to key and potential clients.
  • Customer Communication: Communicate with key customers in foreign markets, determine their insurance needs, and offer relevant products.
  • Team Assistance: Provide methodological assistance to the team in the respective country.
  • Meeting Organization: Organize and conduct meetings with international clients.
  • Market Research: Participate in research for the development of international insurance markets, contribute to new product development, suggest improvements to existing products, and optimize client relations.

7. Insurance Specialist Job Summary

  • Technical Expertise: Bring technical expertise and insight to support the development and delivery of the life risk proposition plan, meeting customer demands using market intelligence.
  • Product Initiatives: Identify product and proposition initiatives that drive business growth and profitability, ensuring a first-class, digitally led customer experience.
  • Pricing Optimization: Work closely with actuarial and reinsurance teams to achieve optimised price models.
  • Stakeholder Collaboration: Drive the individual product and process agenda by collaborating with key internal stakeholders, including Operations, Distribution, Regulatory, and Compliance.
  • Market Alignment: Ensure the product range aligns with changing customer and market requirements through engagement with front-line colleagues and primary market research.
  • Competitive Positioning: Understand and maximise the competitive position.
  • Process Development: Work with Retail Operations, Distribution, and Finance to develop customer-centric business processes.
  • Operational Support: Actively support documentation and maintenance of underwriting, claims, and other key operational processes and procedures.
  • Risk Management: Liaise with product units to identify and manage key business risks.
  • Product Consistency: Ensure consistency between product specifications, policy conditions, and operational solutions.
  • Quality Assurance: Ensure work is completed in a controlled, compliant, timely, and accurate manner with strong attention to detail.
  • Marketing Collaboration: Work closely with the marketing team to define life risk marketing plans.
  • Project Management: Manage ad-hoc projects as required by management.

8. Insurance Specialist Functions

  • Form Assistance: Assist in the completion of insurance forms.
  • Billing Processing: Responsible for processing and follow-up on all insurance and patient billing for services rendered.
  • Claims Submission: Submit insurance claims in a timely manner to meet deadlines.
  • Contract Knowledge: Maintain a thorough knowledge of Medicare, Medicaid, Tricare, and Commercial Contracts.
  • Claims Follow-Up: Assist with insurance companies and follow up on unpaid claims.
  • System Proficiency: Maintain knowledge of electronic submission processes, physician office billing systems, medical terminology, and ICD-9/CPT coding.
  • Staff Collaboration: Work closely with physicians and office staff.
  • Payment Accuracy: Meet customer needs and track the accuracy of insurance payments.

9. Insurance Specialist Essential Functions

  • Policy Placement: Place new policies for clients by navigating the underwriting process, gathering documentation, and reviewing quotes with clients.
  • Renewal Processing: Process group renewals, open enrollments, employee additions and deletions, review plans with employees, and assist with carrier navigation.
  • Invoice Review: Review monthly invoices for accuracy, process payments, and confirm payments to avoid cancellations.
  • Policy Administration: Administer Guild policies (SAG-AFTRA, WGA, DGA).
  • Eligibility Tracking: Ensure client eligibility is current and track to determine when clients may become eligible.
  • Individual Coverage: Assist clients with securing and maintaining individual medical, dental, and vision policies.
  • Client Communication: Interact with clients via email and phone.
  • Coverage Review: Meet with clients to review insurance coverage, bills, pre-authorizations, and related medical, dental, and vision questions.
  • Benefit Coordination: Advise clients, doctors, and hospitals on the coordination of benefits.
  • Claims Guidance: Guide clients through the sign-up process and subsequent claims management.
  • Life Disability Policies: Place and manage life, disability, and long-term care policies for clients.

10. Insurance Specialist Roles

  • Product Advisory: Introduce and advise the most suitable insurance products for each stage of a customer's life (health protection, family, finance, personal property).
  • Customer Experience: Provide customers with the best experience of service quality before and after sales.
  • Contract Support: Complete all the necessary documents for the Client's Insurance contract, and support the client.
  • Urgent Assistance: Quickly, promptly, and satisfactorily deal with urgent/unexpected customer support requests.
  • Cross Selling: Look for opportunities to refer customers to other sales forces at the Bank (e.g., an investment product).
  • Customer Support: Contact when they arise, support requests, questions and answers, and insurance questions.
  • Report Management: Store and update daily/weekly/monthly reports on sales results/customer referral results from the sales force of the Bank.
  • Claims Assistance: Seek medical examination, hand over the insurance record to the Client, and assist the customer in claim procedures and submit claim documents in accordance with the regulations of the Bank and the insurance partner.

11. Insurance Specialist Tasks

  • Policy Administration: Assist in managing or manage the placement and administration of various insurance policies.
  • Renewal Management: Responsible for the Group's insurance renewal process.
  • System Administration: Load contacts and business segments, update forms, including UAT, collection and analysis of underwriting info, administration of the system and engaging with the business segments.
  • Claims Management: Manage insurance claims assigned from notification to settlement.
  • Claims Liaison: Liaise with internal customers, obtain and assess the required information, compile a claims file, and prepare the claims for settlement.
  • Claims System: Administer the claims management system.
  • Report Preparation: Design, coordinate input, compile, review, analyse and submit various manual and system reconciliations and reports (operational, financial, risk, IT, insurance, capital and other), including settlement and outstanding bordereaux.
  • Meeting Coordination: Coordinate and facilitate meetings across the Group, set agendas and prepare and make presentations, take minutes and attend to action items.
  • Stakeholder Support: Provide specialist guidance and support to internal stakeholders on matters relating to group insurance and assist with ad-hoc projects.
  • Service Provider Oversight: Oversight of inputs from service providers and perform monitoring and annual assessment.
  • Regulatory Compliance: Assess regulatory requirements and implement.

12. Insurance Specialist Essential Functions

  • Professional Conduct: Maintain a professional image and demeanor at all times, consistently demonstrating Credit Union RISE Values and adhering to the Code of Ethics.
  • Member Service: Deliver friendly, caring service to internal and external members.
  • Needs Assessment: Meet with members, assess their needs and concerns.
  • Policy Explanation: Explain the features and merits of the insurance policies offered.
  • Coverage Recommendation: Recommend the amount and type of coverage based on analysis of the member's circumstances.
  • Policyholder Support: Assist policyholders with insurance claims, changes in beneficiaries, and renewing or upgrading accounts.
  • Staff Guidance: Provide technical guidance and assistance to staff.
  • Issue Resolution: Research and resolve escalated issues and problems.
  • Referral Training: Provide insurance referral training and work with the Investment Executives to promote financial planning strategies.
  • Request Processing: Document and process requests for new products and services, including, but not limited to, calculating and quoting premium rates, completing applications, collecting premiums to bind coverage, and determining payment methodology.

13. Insurance Specialist Additional Details

  • Risk Evaluation: Evaluate the risk experience against carrier and agency guidelines, including review applications for insurance coverage along with loss reports, driving records, credit standing and other information to determine if the application is acceptable for various agency programs.
  • Lead Management: Manage multiple lead opportunities on a daily basis and assume responsibility for timely contact with prospects and clients without close supervision.
  • Quote Preparation: Prepare quotes from multiple carriers using an automated rating system or directly through the carrier website, and interact with prospects and clients in answering questions while ensuring appropriate coverage is offered to provide adequate insurance protection.
  • Business Placement: Write, place and close business in an efficient manner while also ensuring higher than normal risk is avoided in the book.
  • Goal Achievement: Meet or exceed individual call volume, service and production goals, as established by agency management, on a consistent basis for new and renewal business.
  • Cross Selling: Review current book of business for up-sell, account round, or cross-sell opportunity to round out relationship and improve agency retention, including requesting referrals from family members, friends and other sources.
  • Policy Review: Complete policy reviews, including service requests to assist in maintaining persistence, including cancellations and endorsements, with a focus on retaining business.
  • Record Maintenance: Maintain complete and accurate client profiles, coverage, and business records sufficient to ensure successful compliance audits.
  • Team Collaboration: Operate in a total team environment with the prospect and client's best interests in mind at all times by interacting positively with internal and external teams, including insurance carrier and agency personnel, and affiliate and parent company team members.

14. Insurance Specialist Roles and Responsibilities

  • Patient Support: Answer patient inquiries regarding accounts and assist patients with billing inquiries by providing necessary information and documentation.
  • Payment Research: Research, identify and rectify any special circumstances resulting in delayed payments.
  • Account Review: Review and communicate with patients regarding accounts that have aged over 30, 60 and 120 days.
  • Collections Coordination: Identify and communicate with doctors about non-collectable accounts to be turned over to collections.
  • Payment Posting: Maintain timely posting of all payments and adjustments.
  • Billing Resolution: Solve difficult billing problems, research all information needed to complete the billing process.
  • Account Follow-Up: Work with other staff to follow up on accounts until paid or sent to collection.
  • Payment Assurance: Assure timely payments by patients through statements, letters, phone calls, and follow-up.
  • Code Maintenance: Maintain billing code maintenance file (e.g., payment/adjustment codes), including identifying inappropriate codes and informing staff.
  • Appeal Handling: Address appeals for adjustments in insurance reimbursements.

15. Insurance Specialist Duties and Roles

  • Billing Processing: Daily transmits electronic billing and starts processing of paper claims.
  • Refund Handling: Work on approved refunds for payment.
  • Process Improvement: Work with the supervisor to improve collection, insurance, billing and operational policy/procedures.
  • Meeting Participation: Attend staff meetings and in-service programs.
  • Fee Schedule Management: Maintain fee schedules for Medicare, Medicaid, fee-for-service, PPOs, etc.
  • Referral Management: Maintain referral listings and/or request authorizations from insurance companies for the treatment of patients.
  • Electronic Billing: Daily transmits electronic billing.
  • Manual Maintenance: Maintain a current library of insurance manuals.
  • Coding Library: Maintain the current library of coding books, etc.

16. Insurance Specialist Responsibilities and Key Tasks

  • System Proficiency: Upload and download proficiency, as well as other systems required to perform business functions.
  • UAT Management: Responsible for the development, execution and coordination of user acceptance testing for version implementations.
  • Exception Processing: Responsible for exception processing and Broker Assess production processing following appropriate approval procedures.
  • Issue Triage: Conduct triage of technical issues prior to submission to IT or vendors.
  • Authorization Compliance: Ensure compliance of Travelers brokers through authorization verification and user setup in the appropriate Travelers Companies.
  • Business Collaboration: Maintain cooperative and collaborative relationships with business partners.
  • Corporate Representation: Represent Sales and Distribution as Broker Admin Representative on Corporate Initiatives.
  • Performance Achievement: Consistently achieves and exceeds productivity and quality expectations.
  • Quality Analysis: Administer Quality and Training results analysis, feedback, reports, and suggestions for operational improvement.
  • Staff Training: Provide guidance and training to new or less experienced staff.
  • Quality Meetings: Conduct monthly quality meetings with leadership and conduct and/or coordinate an action plan.
  • Issue Analysis: Research and analyze complex Broker Administration issues related to processing, workflow, quality, backgrounds and systems.

17. Insurance Specialist Key Accountabilities

  • Billing Management: Responsible for all aspects of the accounts receivable billing process for Medicaid insurance and Room and Board billing, including processing any necessary filings for new admissions.
  • Data Accuracy: Ensure all information needed for a claim is entered correctly into the patient management system.
  • Billing Processing: Process and post monthly billing, and complete follow-up billing for subscriber liability.
  • Deadline Compliance: Complete all billing according to the monthly deadlines established by the department.
  • Account Follow-Up: Regularly follows up on past due accounts receivable.
  • Collections Review: Review and actively attempt to collect on a monthly basis.
  • Insurance Documentation: Furnish everything required by insurance companies.
  • Charge Submission: Submit any uncollectible charges to the CFO.
  • Backup Support: Responsible for providing consistent backup support for the Insurance Specialist by performing the following functions, including gathering and documenting patient insurance information.
  • Recertification Coordination: Coordinate insurance recertifications and approval for care.
  • Quality Review: Perform a quality assurance review for data entry for insurance.
  • Standards Compliance: Meet standards set by the Joint Commission and other external organizations, as well as standards set internally by administration and others that relate to this position.
  • Technology Utilization: Responsible to learn and utilizing agency technology made available by the agency to increase efficiency, communication and performance of duties.
  • Meeting Participation: Attend staff meetings and complete all mandatory training.

18. Insurance Specialist Functions

  • Financial Advisory: Understand the financial needs of customers and provide appropriate solutions/advice/guidance and/or recommendations on a range of complex Life and Health Insurance products and services.
  • Relationship Development: Contribute to the growth of the business by developing and deepening new/existing relationships.
  • Customer Engagement: Ask questions and actively listening can effectively offer insurance solutions and deliver legendary experiences to customers.
  • Ownership Mindset: Act Like an Owner by demonstrating pride in business results for all Key Performance Indicators, making sound decisions, and contributing to communities.
  • Operational Execution: Execute with Speed and Impact to protect the Bank from risk by following Standard Operating Procedures as well as federally regulated processes.
  • Purposeful Innovation: Innovate with Purpose by finding ways to simplify, solving problems effectively the first time.
  • Team Development: Develop yourself and Colleagues by embracing diversity and respecting the team.
  • Knowledge Sharing: Share what works and support one another to meet more Customers' needs and achieve personal career goals with TD.

19. Insurance Specialist Accountabilities

  • Document Retrieval: Assist in the retrieval of requested insurance, flood, and/or loss draft-related documents.
  • Clerical Support: Assist in clerical duties related to insurance, flood, and/or loss draft mail.
  • Data Entry: Assist with data entry of insurance, flood, and/or loss draft information.
  • Document Review: Assist in reviewing insurance, flood, and/or loss draft documents.
  • Report Preparation: Assist in maintaining and preparing insurance and/or flood report data and records.
  • Report Monitoring: Work reports are centralized on insurance, flood, and loss drafts monitoring, on a daily, weekly, monthly, and/or quarterly basis.
  • Task Management: Work on insurance and flood-related tasks within MSP.
  • Dispute Handling: Work to handle flood and/or insurance coverage disputes.

20. Insurance Specialist Roles and Details

  • Process Streamlining: Work to streamline insurance, flood monitoring, and loss draft processes.
  • Vendor Communication: Communicate with insurance, flood, and loss drafts vendors.
  • Internal Communication: Communicate with originations and servicing regarding insurance and flood requirements, and loss draft guidelines and requirements.
  • Borrower Support: Communicate with borrowers to resolve inquiries.
  • Complaint Resolution: Assist in researching and resolving complaints.
  • Scorecard Assistance: Assist in vendor scorecard completion on a monthly or quarterly basis.
  • Report Handling: Handle additional reporting as directed by management.
  • Servicing Support: Assist in other areas of Servicing.

21. Insurance Specialist Essential Functions

  • Framework Launch: Drive the launch of the direct insurance distribution framework in PB Asia.
  • Subject Expertise: Act as subject matter expertise and provide training to the floor on insurance.
  • Broker Management: Manage insurance brokers to ensure their business productivity and service level.
  • Pipeline Management: Responsible for managing pipeline activities.
  • Regulatory Compliance: Ensure the insurance sales and referral process and activities are in compliance with both internal and external regulatory requirements.
  • Product Explanation: Explain the features, benefits and drawbacks of specific insurance and/or financial products.
  • Customized Recommendations: Customize recommendations for members and prospective members based on their personal situation and their own goals and objectives.
  • Product Sales: Sell and service products.
  • Customer Service: Provide world-class customer service.

22. Insurance Specialist General Responsibilities

  • Needs-Based Sales: Provide the best services and solutions based on need, and sell based on need.
  • Relationship Building: Build relationships with prospects and clients.
  • Network Expansion: Build a social network to expand the customer base via a digital platform.
  • Data Gathering: Gather prospective clients' data before proceeding to proposal submission.
  • Plan Proposal: Propose a suitable plan to prospective clients based on their financial stability and risk profile.
  • Claims Assistance: Assist clients during the claims process.
  • Agency Participation: Implement the agency system and be involved in company events, training and activities.
  • Strategy Contribution: Responsible for contributing to the delivery of Great Southern Bank's Insurance strategy and performance.
  • Customer Contact: Direct contact with customers over the phone, helping to identify their general individual insurance needs and providing effective solutions through both inbound and outbound calls.
  • Objection Handling: Take time to understand customers' different needs and handle their objections and concerns to provide the best solutions for all customers.

23. Insurance Specialist Details and Accountabilities

  • Partner Relationships: Develop relationships with referral partners.
  • Staff Training: Teach staff how to overcome objections.
  • Continuing Education: Maintain continuing education through the State of Maine.
  • Customer Retention: Foster strong relationships with customers to maintain a high level of client retention and product loyalty.
  • Result Communication: Communicate results with management and owners.
  • Inquiry Response: Respond to incoming customer inquiries in a high-volume inbound call center environment via telephone or in writing.
  • Policy Processing: Support processing functions such as issuing insurance policies, certificates, endorsements, and cancellations for clients, customers, and agents.
  • Problem Resolution: Identify, analyze, and resolve customer and client processing problems or errors that include department premium discrepancies and system problems.
  • Client Communication: Communicate with external clients as well as internal departments.
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