Job Role Description

Medical > Insurance Verifier

Salary National Average

Low Medium High
37640.0000 44630.0000 54370.0000

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Short Description:

Complete the insurance verification/pre-certification process by entering pertinent information into billing systems. Communicate with all insurance companies about patients, confirming patients’ eligibility and benefits. Retain all information about the patient and insurance. Confirm authorization numbers noting the number of days approved. Relay all information, fact sheet, and booking sheet to the billing representative.

Duties / Responsibilities:

  • Examine claims forms and other records to determine insurance coverage.
  • Investigate and assess property damage and create or review property damage estimates.
  • Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review.
  • Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.
  • Negotiate claim settlements and recommend litigation when settlement cannot be negotiated.
  • Analyze information gathered by investigation, and report findings and recommendations.
  • Interview or correspond with agents and claimants to correct errors or omissions and investigate questionable claims.
  • Prepare a report of the findings of the investigation.
  • Refer questionable claims to the investigator or claims adjuster for investigation or settlement.
  • Collect evidence to support contested claims in court.

Skills / Requirements / Qualifications

  • Active Listening: Giving full attention to what other people are saying, taking time to understand the points made, asking questions as appropriate, and not interrupting at inappropriate times.
  • Critical Thinking: Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems.
  • Reading Comprehension: Understanding written sentences and paragraphs in work-related documents.
  • Speaking: Talking to others to convey information effectively.
  • Negotiation: Bringing others together and trying to reconcile differences.
  • Writing: Communicating effectively in writing as appropriate for the audience's needs.
  • Active Learning: Understanding new information's implications for current and future problem-solving and decision-making.
  • Judgment and Decision Making: Considering the costs and benefits of potential actions to choose the most appropriate one.
  • Social Perceptiveness: Being aware of others' reactions and understanding why they react as they do.
  • Complex Problem Solving: Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.

Job Zones

  • Education: Most occupations in this zone require training in vocational schools, related on-the-job experience, or an associate's degree.
  • Related Experience: Previous work-related skill, knowledge, or experience is required for these occupations. 
  • Job Training: Employees in these occupations usually need one or two years of on-the-job experience and informal training with experienced workers. A recognized apprenticeship program may be associated with these occupations.
  • Job Zone Examples: These occupations usually involve communication and organizational skills to coordinate, supervise, manage, or train others to accomplish goals. Examples include food service managers, electricians, agricultural technicians, legal secretaries, interviewers, and insurance sales agents.
  • Specific Vocational Preparation in years: 1-2 years of preparation (6.0 to < 7.0)

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