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Health Insurance Specialist Jobs (NOW HIRING)

Medix

Health Insurance Specialist

Erie, PA · On-site

$25/hr

... an analytical healthcare claims specialist with direct experience handling payment disputes ... As a job position within our Insurance division, a successful completion of a background check may ...

CVS Health

Health Insurance Specialist

Norfolk, VA

$21.10 - $40.90/hr

Oak Street Health Role Description: The purpose of the Patient Relations Analyst (PRA) at Oak Street Health is to educate patients about Medicare programs, resources, and affordable insurance ...

CVS Health

Health Insurance Specialist

Richmond, VA

$21.10 - $40.90/hr

Oak Street Health Role Description: The purpose of the Patient Relations Analyst (PRA) at Oak Street Health is to educate patients about Medicare programs, resources, and affordable insurance ...

CVS Health

Health Insurance Specialist

Cincinnati, OH · On-site

$21.10 - $40.90/hr

Oak Street Health Role Description: The purpose of the Patient Relations Analyst (PRA) at Oak Street Health is to educate patients about Medicare programs, resources, and affordable insurance ...

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$32K

$85.9K

$155.5K

How much do health insurance specialist jobs pay per year?

As of Sep 12, 2026, the average yearly pay for health insurance specialist in the United States is $85,888.00, according to ZipRecruiter salary data. Most workers in this role earn between $51,500.00 and $100,000.00 per year, depending on experience, location, and employer.

What is a health insurance specialist?

Health or medical insurance specialist is a general name given to those who work in a healthcare facility, overseeing financial proceeding for patients. As a health insurance specialist, your responsibilities may include checking for insurance coverage, verifying health information, and liaising with health professionals and patients on all factors related to billing. You may also be responsible for proofreading all billing and medical coding to make sure there are no errors. As this is an umbrella term covering several jobs, your specific duties vary based on your position. You must have excellent organizational skills and may need some post-secondary education training in this career.

What are the key skills and qualifications needed to thrive as a health insurance specialist, and why are they important?

To thrive as a Health Insurance Specialist, you need strong knowledge of insurance policies, medical billing, coding systems, and typically a background in healthcare administration or related certifications. Familiarity with ICD-10, CPT coding, claims processing software, and government regulations like HIPAA is essential. Attention to detail, organizational skills, and effective communication help specialists resolve claims efficiently and interact with patients and providers. These competencies are vital to ensure accurate claims processing, regulatory compliance, and positive customer experiences.

What are some common challenges health insurance specialists face when working with claims processing?

Health Insurance Specialists often encounter challenges such as navigating complex policy details, keeping up with frequently changing regulations, and ensuring the accuracy of claim documentation. Handling discrepancies or denials requires strong attention to detail and effective communication with both healthcare providers and insurance companies. Staying organized and continuously updating knowledge on billing codes and compliance standards are crucial for success in this role.
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Health Insurance Specialist jobs near you
Infographic showing various Health Insurance Specialist job openings in the United States as of September 2026, with employment types broken down into 2% As Needed, 75% Full Time, 17% Part Time, and 6% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $85,888 per year, or $41.3 per hour.

Health Insurance Specialist

Erie, PA • On-site

Medix
Recruiting and Staffing Services • 1 - 5K employees
Learn more about Medixexternal

$25/hr

Full-time

Re-posted 15 days ago

Key responsibilities

  • Evaluate and adjudicate complex out-of-network payment disputes between healthcare providers and health plans in strict accordance with No Surprises Act guidelines

  • Analyze submitted evidence, fee benchmarks, and documentation from both provider and payer to select the appropriate final payment offer

  • Maintain precise, audit-ready case records within federal government portals

Job description

Job Title: Determination Specialist
Position Type: Full-Time / Contract-to-Hire (High growth potential)
Location: Remote (IT Equipment Issued)
Industry: Healthcare / Federal Contracting (GSA)
About the Role
Are you an analytical healthcare claims specialist with direct experience handling payment disputes, provider appeals, or billing arbitrations? We are seeking an experienced Determination Specialist to join our team supporting a federal Independent Dispute Resolution Entity (IDRE) program.
Under the federal No Surprises Act, an IDRE is certified to resolve out-of-network payment disputes between healthcare providers and health plans. In this role, you will leverage your specialized background in provider dispute resolution to evaluate complex documentation, apply federal regulatory criteria, and render final, binding payment determinations for emergency services, facility care, and air ambulance cases.
This position requires demonstrated expertise in healthcare dispute resolution, claims appeals, or out-of-network payment adjudication. If you thrive in an ever-changing environment, excel at solving complex problems in the "grey," and want to apply your dispute experience to high-profile federal oversight, we want to hear from you.
Key Responsibilities
  • Dispute Adjudication: Evaluate and adjudicate complex out-of-network payment disputes between healthcare providers and health plans in strict accordance with No Surprises Act guidelines.
  • Binding Payment Determinations: Analyze submitted evidence, fee benchmarks, and documentation from both provider and payer to select the appropriate final payment offer.
  • Regulatory Compliance: Interpret complex federal and state billing regulations to ensure every dispute determination is legally sound, impartial, and compliant.
  • Case Documentation & Data Entry: Maintain precise, audit-ready case records within federal government portals.
  • Performance Metrics: Manage a active portfolio of dispute cases, meeting strict turnaround deadlines and high quality-assurance standards.

Qualifications & Requirements
Essential Experience (Required):
  • Direct Dispute & Appeals Background: Minimum 2+ years of experience specifically in provider payment disputes, claims appeals, out-of-network reimbursement, or health insurance dispute resolution. (Candidates without direct claims dispute or appeals experience will not be considered.)
  • Analytical Expertise: Demonstrated track record of reviewing complex medical claims, Explanation of Benefits (EOBs), contract terms, and regulatory guidance to solve payment discrepancies.
  • Technical Skills: Advanced data entry skills and proficiency in Microsoft Office (specifically Excel for data analysis and case tracking).
  • Compliance & Screening: Must clear all background checks and meet strict federal conflict-of-interest requirements.

Preferred Knowledge:
  • Education: Bachelor's degree or equivalent combination of specialized dispute-resolution experience.
  • Regulatory Knowledge: In-depth understanding of the Independent Dispute Resolution (IDR) process, the No Surprises Act, and varied plan types (Commercial, Medicare, Medicaid, Self-Funded/ERISA).

Core Competencies & Soft Skills
  • Mastery in Ambiguity: Ability to make sound, independent decisions in complex cases where guidelines require nuanced interpretation.
  • Precision & Detail: High level of accuracy when evaluating conflicting evidence and numerical data from opposing parties.
  • High-Volume Execution: Capacity to maintain quality and speed in a fast-paced environment with a heavy backlog of cases.

What We Offer & Why You Should Join
  • Massive Growth Opportunity: Backed by steady case volume and 50+ open FTE positions, offering exceptional stability and conversion to permanent roles for strong performers.
  • Equipment Provided: Complete IT equipment package provided upon hire.
  • High-Impact Work: Utilize your niche expertise in payment disputes on a vital federal GSA program shaping national healthcare reimbursement standards.

* We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).
* As a job position within our Insurance division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing medical and confidential records, verifying financial information, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients
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About Medix Staffing Solutions

Sourced by ZipRecruiter

Since 2001, we’ve been dedicated to helping you achieve your goals. Medix was created to become a leading provider of workforce solutions for clients and candidates across the healthcare and life sciences industries. Today, we are that leader. Headquartered in Chicago, we have 23 offices across the United States, and staff talent around the world. Medix is committed to fulfilling our core purpose as an organization: to positively impact the lives of our talent, clients, and teammates through employment, philanthropy, and opportunity. The combination of purpose and values has nurtured our thriving culture that encourages our internal team to excel at work and in everyday life.

Industry

Recruiting and staffing services

Company size

1,001 - 5,000 Employees

Headquarters location

Chicago, IL, US

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