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Health Insurance Specialist Jobs (NOW HIRING)

CVS Health

Health Insurance Specialist

Albuquerque, NM

$21.10 - $40.90/hr

The purpose of the Health Insurance Specialist, internal called the Patient Relations Analyst (PRA), at Oak Street Health is to educate patients about Medicare programs, resources, and affordable ...

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Health Insurance Specialist information

See salary details

$32K

$85.9K

$155.5K

How much do health insurance specialist jobs pay per year?

As of Aug 3, 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 do health insurance specialists do?

Health insurance specialists review and process insurance claims, verify coverage, and assist clients with policy questions. They often work with insurance databases and require knowledge of healthcare regulations and billing procedures to ensure accurate and efficient service.

How to become a health insurance specialist?

To become a health insurance specialist, typically one needs a high school diploma or equivalent, followed by relevant training or certification in health insurance policies and regulations. Many employers prefer candidates with knowledge of healthcare systems, customer service skills, and familiarity with insurance software. Earning certifications such as the Certified Health Insurance Specialist (CHIS) can enhance job prospects.

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 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.

What qualifies as a specialist for health insurance?

A health insurance specialist is a professional knowledgeable in health insurance policies, regulations, and coverage options. They often hold relevant certifications, such as the Certified Health Insurance Specialist (CHIS), and have experience with insurance claims, customer service, and policy administration. Strong communication skills and familiarity with insurance software are also important qualifications.

What is the highest paying position in insurance?

In the insurance industry, executive roles such as Chief Executive Officer (CEO), Chief Underwriting Officer, and Chief Risk Officer tend to be the highest paying positions. These roles require extensive experience, leadership skills, and often advanced certifications, and they oversee company strategy and risk management at the highest level.

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 Health Insurance Specialists?

Health Insurance Specialists are professionals who process, review, and manage health insurance claims, ensuring compliance with regulations and accuracy in billing and reimbursement. They often work in hospitals, clinics, insurance companies, or government agencies and serve as a liaison between patients, healthcare providers, and insurance companies. Their responsibilities may include verifying patient benefits, coding medical procedures, addressing claim denials, and providing guidance on insurance policies. Health Insurance Specialists play a crucial role in helping patients understand their coverage and in ensuring that healthcare providers receive proper payment for their services.
More about Health Insurance Specialist jobs
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What are popular job titles related to Health Insurance Specialist jobs? For Health Insurance Specialist jobs, the most frequently searched job titles are:
Health Insurance Specialist jobs near you
Infographic showing various Health Insurance Specialist job openings in the United States as of July 2026, with employment types broken down into 1% As Needed, 77% Full Time, 16% Part Time, and 6% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $85,888 per year, or $41.3 per hour.

Health Insurance Specialist

Department of Human Services

Boston, MA

$108K/yr

Other

Re-posted 29 days ago

Job description

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS).
As a Health Insurance Specialist, GS-0107-13, you will perform program policy work related to national health insurance programs, such as Medicare, Medicaid, the Children's Health Insurance Program (CHIP), and Marketplace Exchange/private health insurance.Qualifications:ALL QUALIFICATION REQUIREMENTS MUST BE MET BY THE CLOSING DATE OF THIS ANNOUNCEMENT.
Your resume (limited to no more than 2 pages) must include detailed information as it relates to the responsibilities and specialized experience for this position. Evidence of copying and pasting directly from the vacancy announcement without clearly documenting supplemental information to describe your experience will result in an ineligible rating. This will prevent you from being considered further.
In order to qualify for the GS-13, you must meet the following: You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-12 grade level in the Federal government, obtained in either the private or public sector, to include: (1) Conducting analysis of national health insurance program policy issues in order to propose policy modifications; (2) Developing regulations, manuals, program guidelines, program memoranda, policy letters, or instructions to communicate health insurance program policies; and (3) Presenting recommendations and conclusions based on analysis and evaluation of health insurance programs that describe feasible options or the consequences.
Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional, philanthropic, religious, spiritual, community, student, social). Volunteer work helps build critical competencies, knowledge, and skills, and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience.
Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/13006731Education:This job does not have an education qualification requirement.Employment Type: OTHER

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