Insurance Specialist Resume Sample

Position Overview

The job of an insurance specialist requires an individual to examine health insurance claims to determine claim holders’ or providers’ need for payments.

It is a challenging position which requires a lot of investigation into insurance coverage and billing statements.

Applicants who wish to apply for this position need to portray an acute understanding of the workings of insurance companies and types of claims when they write their resume.

Insurance specialists process medical insurance claims to decipher the need for paying out insurance claims. They monitor delinquent accounts and perform some collection duties. They also identify denied claims, perform reconciliation of records and resubmit rejected claims to payers.

If you are preparing your application for an Insurance Specialist job, the following resume sample will help you to build a useful job application package.


Insurance Specialist Resume Example



Solomon Craig

376 Coolpoint Road ● Indianapolis, IN 66663 ●  Cellular: (999) 999-9999 ● Email


Focused and results-driven Insurance Specialist with 12+ years’ dedicated experience in the insurance industry. Highly qualified in reviewing, analyzing and interpreting insurance policies. Hands-on experience in monitoring and managing disbursement of payments. In-depth knowledge of initiating and overseeing insurance coverage directives. Proficient in submitting and resubmitting claims and suggesting action plans to eliminate denials.


• Delinquent accounts monitoring • Customer service
• Denied claims identification • Service activity monitoring
• Electronic workflow completion • Front desk assistance

• Managed payment of a particularly difficult claim after it was denied three times
• Set up a system that monitors delinquent accounts automatically thereby reducing research time
• Increased the client base of the company by 15% in three months using diverse business solicitation methods
• Successfully obtained underwriting approval for coverage for a particularly tricky to pass insurance policy


Kaleida Health, Indianapolis, IN                   2008 – Present
Insurance Specialist
• Ensure resolution of submitted claims in a time-efficient manner
• Handle billing related activities focused on medical specialties
• Ensure that appropriate coding is managed to maximize efficiency
• Verify patient insurance information
• Resubmit claims when denied or edited
• Determine the appropriateness of payers
• Post payments to accounts and maintain records
• Train newly hired insurance representatives

HCR Home Care – Rochester, NY                2006 – 2008
Insurance Representative
• Assessed clients’ insurance needs by conferring with them
• Formulated insurance plans to help meet clients’ coverage needs
• Approached potential clients by using different mediums such as telephone and mail
• Assisted existing clients with questions and problems
• Assessed clients’ financial position in order to manage an appropriate coverage plan
• Ensured timely payment of claims

Rochester City College, Rochester, NY – 2005
Associate’s Degree in Accounting

• Exceptional knowledge of insurance follow-up procedures
• Ability to analyze and resolve problems effectively
• Effective written and oral communication skills

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