Geprüfter Berufsspezialist in der gesetzlichen Krankenversicherung/Geprüfte Berufsspezialistin in der gesetzlichen Krankenversicherung

Preparatory courses for the examination take place, for example, at health insurance academies or other educational institutions. For in-person events, the learning locations are training rooms. For digital learning forms (e.g., virtual classroom) and distance learning, the learning locations are at home, and possibly training rooms during in-person phases. For combined learning forms (e.g., blended learning), training rooms are used for in-person events, and home for online learning units.

Occupation type: Advanced training occupation: Specialist. Type of advanced training: Advanced training or advanced training examination according to the regulations of the competent bodies in the healthcare sector. Duration of advanced training: Varies, 1-2 years (part-time) - depending on the educational offer and learning format. Tasks and activities: Specialists in statutory health insurance support customers at a health insurance company. They process complex benefit cases, for example, in hospital case management, check hospital bills, or assess the duration of inpatient stays. They also calculate contributions and advise members on insurance questions, financing, and health insurance benefits. In marketing, they plan measures to attract new members, while in quality management, they analyze operational processes and develop optimization proposals. In financial controlling, they create forecasts and participate in the preparation of budgets and annual accounts.

Varies, depending on the educational offer and learning format: Part-time: 1-2 years.

Course fees are incurred for attending preparatory courses, and examination fees for the examination itself. Further costs may arise, for example, for working materials, travel to the training center, or external accommodation. Funding opportunities: Preparatory courses for the advanced training examination can be financially supported according to the Advanced Training Assistance Act (Aufstiegsfortbildungsförderungsgesetz). Further information: Aufstiegs-BAföG - Advancement with Funding. Funding for particularly talented young specialists: Stiftung Begabtenförderung berufliche Bildung (SBB) - Advanced Training Scholarship.

Insurance and contribution law, e.g.: Wages from a contribution law perspective, Basic principles of insurance law, Contribution calculation and billing, Insurance and contribution law questions for selected groups of people, Family insurance. Benefit law, e.g.: Continued payment of wages and sickness benefit, Case and care management, Medical treatment, Long-term care insurance, Rehabilitation, Pregnancy, maternity and family planning, Compensation, Accident insurance, Reimbursement claims. Interdisciplinary content, e.g.: Basic business administration concepts and facts, The choice of location and legal form as an operational decision problem, Corporate taxes, Budgeting and accounting, Health fund and morbidity-oriented risk structure equalization, Marketing and competition, Market research, -goals and -strategies, Marketing instruments, Sales, Administrative procedures, data protection and criminal law.

In-depth knowledge in the following areas are good prerequisites for successfully passing the advanced training examination: Law: e.g., to decide on continued payment of wages or insurance obligations. Organization/Administration: e.g., to coordinate work in a team and efficiently handle procedures.

This advanced training consists of theoretical lessons and, if necessary, practical exercises. Depending on the education provider, one should expect the following conditions: class times are usually part-time, on weekends or in the evening. For in-person events, classes take place in a classroom setting at the educational institution. For digital learning forms (e.g., virtual classroom), learning occurs exclusively via electronic learning platforms and systems from home. For combined learning forms (e.g., blended learning), there are in-person classes at the educational institution and self-directed learning via electronic learning platforms and systems from home. For distance learning, individual processing of learning material takes place from home, requiring high self-discipline and work organization; there may also be additional in-person phases at the educational institution.

Participation in preparatory courses is not remunerated.

The following advanced training alternatives are available for the profession of Geprüfter Berufsspezialist/in in der gesetzlichen Krankenversicherung (Certified Professional Specialist in Statutory Health Insurance): In the field of Health and Social Management, options include Betriebswirt/Betriebswirtin (Fachschule) für Management im Gesundheitswesen/Bachelor Professional in Wirtschaft (Business Administrator (Technical College) for Health Management/Bachelor Professional in Business) or Betriebswirt/Betriebswirtin (Fachschule) für Sozialwesen (Business Administrator (Technical College) for Social Services). The commonality is taking on specialist and leadership roles in health and social management. In the field of Accounting and Controlling, the option is Betriebswirt/Betriebswirtin (Fachschule) für allgemeine Betriebswirtschaft/Bachelor Professional in Wirtschaft (Business Administrator (Technical College) for General Business Administration/Bachelor Professional in Business). The commonality is taking on specialist and leadership roles in accounting and controlling.

In the 1970s, the Fachwirt (specialist) advanced training was developed under the leadership of the German Chamber of Industry and Commerce (DIHT). In 2007, legal provisions for the advanced training examination by the competent authorities in the healthcare sector came into force. In 2020, the Berufsbildungsgesetz (BBiG - Vocational Training Act) and the Handwerksordnung (HWO - Crafts Code) were amended, introducing advanced training qualifications such as 'Geprüfte/r Berufsspezialist/in' (Certified Professional Specialist), 'Bachelor Professional,' and 'Master Professional' to emphasize the equivalence of vocational and academic education. The use of these professional titles depends on the enactment of corresponding new advanced training regulations. In 2023, the ordinance for conducting the advanced training examination for Krankenkassenfachwirt/in (Health Insurance Specialist) and Geprüfter Berufsspezialist/in in der gesetzlichen Krankenversicherung (Certified Professional Specialist in Statutory Health Insurance) came into force. In 2024, the Berufsbildungsvalidierungs- und -digitalisierungsgesetz (Vocational Training Validation and Digitalization Act) with adjustments to the Berufsbildungsgesetz (BBiG) came into force.

Depending on the competent authority, titles such as Krankenkassenfachwirt/Krankenkassenfachwirtin (Health Insurance Specialist), Geprüfter Berufsspezialist in der gesetzlichen Krankenversicherung/Geprüfte Berufsspezialistin in der gesetzlichen Krankenversicherung (Certified Professional Specialist in Statutory Health Insurance), or Krankenkassenfachwirt/Krankenkassenfachwirtin (Health Insurance Specialist) may be used.

Geprüfter Berufsspezialist (Certified Professional Specialist) in der gesetzlichen Krankenversicherung is a vocational advanced training. The examination is regulated by the legal provisions of the competent authorities in the healthcare sector. This advanced training lasts 1-2 years when pursued part-time.

After this advanced training, specialists in statutory health insurance work for statutory health insurance funds and other social security institutions. You can keep your specialist knowledge up-to-date, bring it to the latest standard, and expand it through adaptive advanced training. The range of topics extends from Case Management to Controlling. To advance professionally, you can expand and supplement your competence profile based on existing qualifications. It is logical to complete advanced training as a Business Administrator for Administration. With their advanced training qualification, specialists in statutory health insurance can gain access to a university (Studium) even without a school-leaving higher education entrance qualification and, for example, acquire a Bachelor's degree in Social Insurance.

For the examination, the competent authorities in the healthcare sector issue advanced training and examination regulations. For example: Regulation on the implementation of the advanced training examination for Krankenkassenfachwirtin, Krankenkassenfachwirt, Geprüfte Berufsspezialistin, Geprüfter Berufsspezialist in statutory health insurance in the state of North Rhine-Westphalia (Bundesland) (Fortbildungsprüfungsverordnung Krankenkassenwirtin, Krankenkassenfachwirt - FPVO-KKFW) of 22.11.2023 (GV. NRW. S. 1236). Overview of the competent authorities in the healthcare sector: Krankenkassenfachwirt/Krankenkassenfachwirtin, regulations of the competent authorities for professional advanced training.

The prerequisite for admission to advanced training is usually: the final examination as a Social Insurance Clerk (Sozialversicherungsfachangestellte/r) in the field of general health insurance or another previous qualification in conjunction with relevant professional activity. The prerequisite for admission to the advanced training examination is usually: the final examination as a Social Insurance Clerk and participation in an advanced training course or professional activity with insurance providers in conjunction with relevant previous qualification and participation in an advanced training course.