What does a health insurance professional do?
Health insurance professionals are responsible for reviewing medical insurance claims in order to provide members with the medical service or care they have requested. They review claim cases and process these for authorisation, or in some cases, reject claims based on certain criteria not being met. Health insurance professionals also deal with co-payments and shortfalls, which means they are experts at understanding health insurance plans and policies, including limitations and exclusions.
How to get a job in healthcare insurance?
These are a number of recommended steps to follow if you’d like to know how to work for health insurance companies. These are the three steps to keep in mind:
1. Decide on a healthcare field. Give some thought about which area of healthcare insurance you’re passionate about and pursue a career in that particular field.
2. Obtain a relevant qualification. It’s not always possible to get a job in healthcare insurance without a degree or diploma. Although there are some basic positions available without any formal training or qualifications, it is advisable to get a healthcare administration degree or diploma so that you’re properly trained for the profession. This will also go a long way in promoting your career advancement.
3. Secure employment and gain experience. Once you’ve started work at an insurance company, hospital or clinic, you can obtain significant experience in your field and advance your career through learning and development programmes, or through mentorship.
Healthcare jobs in insurance companies
Some of the top jobs available in the healthcare insurance industry include:
- Medical insurance claims specialist. These specialists are responsible for processing information that is required for health insurance claims. They could, for instance, collect information about a pending claim.
- Medical insurance billing specialist. These healthcare insurance specialists are responsible for ensuring that all essential services are covered, in addition to processing health insurance claims. They need to be proficient in medical coding and medical billing software. They could, for instance, deal with billing members for medical bills not covered by the health insurance plan.
- Insurance underwriters. These specialists are responsible for determining risk factors when evaluating insurance claims and applications. They are also responsible for calculating health insurance premiums based on these risks.
- Medical coding specialist. This type of health insurance specialist deals with converting insurance claims into standardised coding.
- Health insurance broker. This is the professional who advises people about their health insurance plan options and sells them a policy that suits their medical needs and budget.
Benefits of working in healthcare insurance
- Job security. This is an industry with many marketable opportunities due to the fact that it is an essential service.
- A variety of positions. There are also different types of positions available within the healthcare insurance sector, so workers are able to specialise in a particular field that suits their style of work or passion.
- Rewarding work. Those who work in the healthcare insurance industry find it very gratifying as they’re providing a much-needed service to those who could be suffering from an illness, disability or condition. Those in healthcare can assist them in finding treatment and relief.
- Compensation. The healthcare industry provides a competitive salary to workers in this industry, dependent on their years of service and seniority level.
- Flexible working conditions. It’s not routine work. Many healthcare insurance jobs offer flexible hours, which means that workers can choose their own shifts or schedule. The industry is also stimulating and fast-paced, which means you will deal with daily challenges to keep you on your toes.
Type of personality traits you need to work in healthcare
1. Good communication skills. It’s essential to be able to communicate effectively with patients or health insurance members. People need to understand the implications of a disease or condition so they can make lifestyle changes, manage a condition or take medication. Likewise, healthcare professionals also need good listening skills in order to help patients and insurance members.
2. Emotional intelligence. Not only does one need to remain calm under pressure, but you will also need to be sensitive and care for those who are frightened and anxious.
3. Attention to detail. Accuracy is a big priority in healthcare. From keeping up-to-date records to assessing and analysing results, and processing claims, your ability to ensure that details are kept precise and correct will go a long way in ensuring a patient or insurance member receives the best possible care.
4. Adaptable. No two days are the same in the healthcare industry so it’s unwise to consider this line of work if you’re into a regimental routine. While it’s good to have systems in place for quality checks, one must be prepared to be flexible in order to ensure the patients or insurance member receives proper care.
5. Numerical. It’s important to remember that healthcare insurance professionals should be good at dealing with numbers, like finance and accounting, as this forms an integral part of the job.
Health insurance cover from Momentum Health4Me
Bloom is committed to providing affordable health insurance to South Africans. Our health insurance plans guarantee top-quality healthcare services and access to private hospital facilities. Get a health insurance plan you can afford and trust. Contact Bloom’s office to speak to a trained consultant about our health insurance plans.
Medical Content Disclaimer
You understand and acknowledge that all users of the Bloom Financial Services website are responsible for their own medical care, treatment, and oversight. All content provided on the website, is for informational purposes only and does not constitute medical advice. Neither is it intended to be a substitute for an independent professional medical opinion, judgement, diagnosis or treatment.