Claims Processor Resume Sample
Winnifred Koelpin
254 Ramona Squares,
Chicago,
IL
+1 (555) 569 0667
Work Experience
Claims Processor Associate
01/2016
-
PRESENT
Dallas, TX
- Upervisory experience desired.In-depth knowledge of all aspects of benefits claims processing, claims adjudication principles and procedures, medical terminology and procedures, and ICD-10 and CPT coding
- Prior healthcare claims auditing experience required
- Manage a large work volume and meet deadlines
- Collaborate with others and work effectively within a team environment
- Quickly use a 10-key machine- Experience with list of ICD-9 codes and Current Procedural Terminology (CPT) Claims
- Applies current knowledge of detailed billing requirements, claim attachments and rejections
- Has knowledge of, and is compliant with, government regulations including "signature on file" requirements, compliance program, HIPAA, etc
- Work includes cross coverage in other areas of department as needed
- Participates in performance improvement projects and activities as needed
Claims Processor
09/2008
-
07/2015
San Francisco, CA
- Identify accumulators that appear suspicious to management for further investigation
- Maintain and update required reference materials for accumulators
- Reviews individual applications for Payment Protection business to determine eligibility for coverage and adherence to each financial institution's specific program parameters
- Assists with the follow-up requests for medical records, continuing claim reports (PR's), and other information related to claims that are on the "no activity report"; and documents such within the claim files and Electronic Data Management System (EDMS)
- Creates and mails letters and follows-up on correspondence to the applicant and the financial institution related to a change in or denial of coverage; ensures all correspondence/information is documented and filed with the associated application in the EDMS system
- Prepares and submits check requests to Accounting for payment of invoices from physicians and other medical facilities for medical records; and prepares a report for reimbursement from the insurance company
- Maintains the database for correspondence in MS Access and updates the instruction manual; maintains files that document eligibility requirements and the application process for each financial institution client
- Prepares application activity reports for distribution to internal and external customers
Citi Commercial Bank-junior Claims Processor
03/2002
-
06/2008
Chicago, IL
- Three years (recent) of physician office or related healthcare experience required
- Assimilate and synthesize information
- Demonstrates the ability to understand and effectively utilize a highly complex billing system(s)
- Maintains current knowledge of all Federal, State and compliance regulations related to billing and insurance as required based on the scope of the position
- Demonstrates an understanding of HCFA 1500 claim forms, CPT, ICD.10 and HCPCS codes specific to insurance carrier requirements as required based on scope of the position
- Experience in claim operation environment, preferably pricing claims
- Function as technical specialist for accumulators. Analyze complex operational accums problems and provide technical solutions. Identify and recommend areas where changes to existing processes and procedures can result in process and/or cost savings. Provide support to various IT staff
- Identify key issues with projects and offer solutions
Education
Indiana Wesleyan University - Kokomo Campus
1996 - 2001
School's Degree in Computer
Professional Skills
- Knowledge, Skills and Abilities: Basic computer skills, including Word and Excel; keyboarding/data entry skills
- Knowledge, Skills and Abilities: Basic computer skills, keyboarding/data entry skills
- Strong organizational skills and oral/written communication skills
- Strong working knowledge of Microsoft Office suite; strong analytical and decision making skills
- Strong verbal communication skills including an excellent phone manner
- Strong computer skills, including previous data entry experience
- Necessary mathematical skills and effective oral and written communication skills
How to write Claims Processor Resume
Claims Processor role is responsible for computer, basic, organizational, microsoft, analytical, telephone, interpersonal, customer, insurance, windows.
To write great resume for claims processor job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Claims Processor Resume
The section contact information is important in your claims processor resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:
- First and last name
- Telephone number
Work Experience in Your Claims Processor Resume
The section work experience is an essential part of your claims processor resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous claims processor responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular claims processor position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Claims Processor resume experience can include:
- Good oral and written communication skills; previous experience using PC, database system, and related software (MS Word, Excel, etc.)
- Good communication skills and the ability to establish effective working relationships with all levels of staff
- Strong organizational skills - ability to prioritize, plan, follow-up to completion
- Knowledge, Skills & Abilities: Attention to detail and organizational skills required
- Strong research, judgment, decision-making and problem-solving skills
- Effectively manage multiple competing priorities to ensure timely project completion
Education on a Claims Processor Resume
Make sure to make education a priority on your claims processor resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your claims processor experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.
Additional details to include:
- School you graduated from
- Major/ minor
- Year of graduation
- Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.
Professional Skills in Claims Processor Resume
When listing skills on your claims processor resume, remember always to be honest about your level of ability. Include the Skills section after experience.
Present the most important skills in your resume, there's a list of typical claims processor skills:
- Basic computer abilities (navigating with MS Windows and MS Internet Explorer, solid keyboard and typing skills)
- Excellent computer skills and comfortable working with various claims processing platforms
- Knowledge, skills and abilities as normally obtained through two years of experience in medical claim processing
- Experience in business operations by effectively communicating between other functional departments
- Reliability and attendance great customer service skills, excellent ability to communicate claims information to customers'
- Excellent interpersonal skills needed to promote a positive work environment
List of Typical Experience For a Claims Processor Resume
1
Experience For Claims Processor Associate Resume
- Good organizational, telephone skills and detail oriented
- Good analytical and comprehensive skills
- Able to work effectively in a changing environment
- Relevant Work Experience: 2 years work experience required
- Experience processing medical claims or working within a Managed Care Organization with direct interaction with the Claims Department
- Experience with pricing claims
- Previous experience processing medical claims
2
Experience For Immediate Need for a Medical Claims Processor {west Houston} Resume
- Demonstrated knowledge of claim regulations, including AB1455, ERISA and Knox Keene Act
- Experience with claims approvals, authorization processes and extended warranty claim adjudication
- Cooperate with clients and associates as a team player with a positive attitude
- Insurance Knowledge - 2+ years customer service experience within managed care, medical or insurance environment
- Proven Customer Service Abilities and Orientation
- Documents and updates internal database based on daily contact of select members of assigned applicant group and application evidence requirements
- Related administrative experience
3
Experience For Warranty Claims Processor Resume
- Approving, pending, or denying payments according to the accepted coverage guidelines
- Approving, denying, or pending payment according to plan
- Issuing payments to lenders and customers, ensuring compliance and data integrity of electronic claim files, and processing salvage data
- Taking inbound calls and making outbound calls to acquire the necessary information for Medicare Part D paper claims
- Processing and adjudicating Medicare Part D paper claims
- Researching and resolving inquiries for bills/services
- Performing data entry and processing of invoices
4
Experience For Occupational Health Services Claims Processor Resume
- Contributing to billing cycles
- Researching and resolving incorrect purchase orders
- Answering Incoming phone calls to the department
- Monitoring the operating condition of all office equipment and inventory/supplies
- Posting and reconciling batches
5
Experience For Trade Claims Processor Resume
- Answering inbound phone calls and providing support for multiple client groups
- Navigating company website and obtaining Labor times and codes
- Invoicing and downloading repair orders/claims to website
- Processing and adjudicating paper claims
- Processing and adjudicating Aetna Commercial paper claims
- Learning the activities/tasks associated with his/her role. Works under direct supervision
- Processing and adjudication of paper claims
6
Experience For Lead, Claims Processor Resume
- Entering high volume data entry policy transfers
- Working Knowledge of Electronic Claims Submissions
- Completing reports as directed by management
- Ensuring customer satisfaction and strive to meet service standards
- Collaborating with management or other team members as appropriate to proactively address service issues and concerns
- During claims investigations, ability to interact successfully with other company departments outside of immediate supervision
7
Experience For Ipmi Claims Processor Resume
- Protecting the confidentiality of our customers’ personal health information
- Securing titles, lien releases power of attorney and other required documents from lien holders and customers (first and third party)
- Interacting with internal and external customers and business-to-business contacts
- Gaining customer loyalty through the delivery of exceptional service
- Producing a high quality work product in a high volume work environment
8
Experience For Occupational Health Claims Processor Resume
- Collaborating with team members and event owners
- Building benefits in systems
- Auditing own work, work of others
- Tracking received data and source documents
- Processing warranty claims on a timely basis for each franchise or distributor
- Verifying criteria required by factory or distributor
- Reviewing repair orders to determine failure
- Preparing all warranty paperwork to ensure proper documentation
- Arranging for parts to be shipped to the factory or distributor, or to be scrapped
9
Experience For Claims Processor, Rcis Crop Claims Resume
- Keeping informed of all factory recalls and bulletins
- Maintaining a professional appearance and a neat work area
- Analyzing benefit documents
- Filing conveyance claims
- Entering basic claims
- Processing and adjudicating claims from various commercial employer and healthplan clients
- Working within trurnaround times to meet Federal CIA requirements
10
Experience For Hospital Claims Processor Resume
- Provide expertise or general support by reviewing, researching, investigating, negotiating, processing and adjusting EPS enrollments
- Coordinate and implement training of claims processors on policies, procedures, systems, and proper coding and processing
- Work in an environment that requires repetitive motion such as keying, copying and scanning
- Current knowledge of policy coverages, claims procedures including claims and underwriting training in insurance policies
- Assist when needed with the internal mail processes which includes batching and scanning of paper claims and attachments
List of Typical Skills For a Claims Processor Resume
1
Skills For Claims Processor Associate Resume
- Demonstrated ability to work on multiple tasks concurrently and to work effectively across functional areas
- Knowledge and skills to create and distribute weekly and monthly reports, including exception reporting
- Sets daily priorities and manages time efficiently; seeks input when changing or competing priorities arise
- Claims processing experience in Managed Health Care/Insurance experience is highly desirable
- Basic computer skills required, including Word, Excel, and Outlook
2
Skills For Immediate Need for a Medical Claims Processor {west Houston} Resume
- Relevant Work Experience: 1- 2 years of data entry/processing experience required
- Customer service and telephone skills
- Work collaboratively and effectively with peers, management and legal counsel as necessary to accomplish work tasks
- Accurately and effectively communicate information to and from internal and external stakeholders in regards to policies and procedures
- Computer skills and keyboard proficiency
- Proficient in MS Outlook and Excel, Type 45wpm, 3+ years Data Entry Skills,
- Proficient in MS Outlook and Excel, Type 45 wpm, 3+ years Data Entry Skills,
- Timely, efficient, and accurate data entry skills
- Effectively interact with multiple business partners
3
Skills For Warranty Claims Processor Resume
- Above average telephone techniques and the ability to effectively communicate with clients, carriers, and other staff members
- Moderate skills in using Microsoft Office products required
- Moderate verbal, telephone and written communication skills required
- 10 key data entry & hot key skills required
- Working experience utilizing a PC including Word, Excel, and MS Outlook
- Testing: Typing 30 WPM or keystrokes equivalent (able to pass all skill assessments)
- Working experience processing multiple fee schedules and contracts
4
Skills For Occupational Health Services Claims Processor Resume
- Billing and follow-up experience
- Previous experience with filing, data entry and general administrative tasks, including copying and scanning
- Timely, accurate scanning and validation of incoming paper claims using the Datacap system
- Some experience in medical coding, billing or claims examination
- Demonstrated aptitude for data, reporting, and working with numbers, desired
- Demonstrated ability of achieving desired outcomes in a complex and rapidly changing environment
5
Skills For Trade Claims Processor Resume
- Experience working with CMS-1500 and UB-04 claim forms, CPT, HCPCS, Revenue Codes and ICD-10 coding
- Knowledgeable in Medical coding (including CPT4, HCPCs, ICD-9) with EMR experience
- Strong understanding of standard insurance procedures (pricing, exclusions, etc.)
- Paid Training at $11 an hour, $12 if experienced in Calims Processing
- Validation - Determine incentive payment eligibility by reviewing claim documents using knowledge of business rules
- Research and validate customer’s or vendor’s invoices to ensure authorized promotional and non-promotional spending according to NWNA SOP's
- Experience working with CMS-1500, RBRVS, CRVS, UB04, CPT, HCPCS, DOFR and ICD-9/10 coding
6
Skills For Lead, Claims Processor Resume
- Strong "customer-focused" individual with a passion for responding to the needs of customers
- Claims processing and provider experience
- Claims Processing experience
- Previous experience working in an HMO or Medicare Managed Care environment
- Previous experience in Processing
- Experience using Microsoft Office to manage emails
- Claim processing experience in HCFA 1500 and UB92s
- Applicable Medicare Advantage and/or Claims Processing experience
7
Skills For Ipmi Claims Processor Resume
- Experience keying claims
- Experience in using excel to create and maintain spreadsheet, Word for documentation
- Experience working in the Healthcare/Medical Industry
- Related claims processing experience in healthcare required
- Experience working Denials and correspondence
- Experience with billing system
- Experience with obtaining authorization
- Experience in Claims Processing/Claim Adjudication environment
- Experience in a customer service or customer support role, usually in an office setting, call center, or phone support role
8
Skills For Occupational Health Claims Processor Resume
- Develop a solid understanding of assigned client’s process and payors in order to properly identify the claims that require paper submission
- Experience using Microsoft Excel and Word to create and maintain spreadsheets, and for documentation
- Experience processing claims
- Related, progressive experience in claims processing
- Maintain workflow in a current status through demonstrated proficiency in dashboard and exception reporting tools
9
Skills For Claims Processor, Rcis Crop Claims Resume
- Review and audit each batch of claims entered to identify entry errors prior to processing
- Provider and Claims experience
- 1 year of customer service experience or an Associate's in criminal justice
- Quickly use a 10-key machine- Experience with list of ICD-9 codes and Current Procedural Terminology (CPT)Claims
- Demonstrated knowledge of LANL systems such as Concur
- Establish and maintain effective working relationships with the public and other DHHS personnel
- Audit every 25th inbound claim against workorder for validation, and reconcile audit findings from outside groups
- Strong aptitude for new programs
- Experience with data entry in a production environment
10
Skills For Hospital Claims Processor Resume
- Proven knowledge of CPT, HCPCS, ICD-9/ICD-10, DRG’s, RBRVS codes and medical terminology for both electronic and paper claims
- Excellent customer service philosophy
- Claims processor experience
- Demonstrate sense of urgency based on business demands
- Computer skill required: Microsoft Office, SAP, TPM/Hydro
- Medicare claims experience required
List of Typical Responsibilities For a Claims Processor Resume
1
Responsibilities For Claims Processor Associate Resume
- Knowledge, Skills & Abilities: Basic computer skills required
- Strong communication skills and an ability to work as a team player
- Strong skills in Windows PC applications, which and the ability to learn new and complex computer system applications
- Ensure work is prioritised effectively
- Excellent computer skills, able to work in Microsoft Office programs efficiently
- Effectively handle incoming telephone enquiries/requests, processing/referring as appropriate
2
Responsibilities For Immediate Need for a Medical Claims Processor {west Houston} Resume
- Manage customer instructions through the development of high quality interpersonal skills
- Demonstrate success working in a team environment while independently completing assignments consisting of numerous steps that vary in nature and sequence
- Experience handling damage, shortages and overages in the transportation industry
- Act as a referral point for less experienced team members; sharing knowledge and expertise
- Escalates non-routine or potential denied claims to more experienced claims processors or supervisor
- Identify and send out of network claims for discount negation prior to payment
- Experience handling customer support issues - ideally in a safety or claims environment
- Experience in medical administration, claims environment or customer service focused organisation
- Case and Claims management system experience
3
Responsibilities For Warranty Claims Processor Resume
- Knowledge and/or experience in benefit interpretation
- Experienced with 10-key punch required
- Related business experience (preferably in claims)
- Experience with data entry in a production environment
- Experience in insurance industry
- Quickly use a 10-key machine- Experience with list of ICD-9 codes and Current Procedural Terminology (CPT)
4
Responsibilities For Occupational Health Services Claims Processor Resume
- Experience in Claims Processing/Claim Adjudication environment
- Default-related experience is required
- Claims Experience
- Previous customer service experience preferably in an office or medical environment
- Demonstrated knowledge of DMHC claims compliance standards
5
Responsibilities For Trade Claims Processor Resume
- Demonstrated medical terminology knowledge
- Demonstrated ability to: a. lead and motivate staff b. understand COB guidelines
- Tracking of payments/invoicing
- Typing speed of at least 20 words per minute
- Working with Dealers to Ensure Claims are Processed Quickly
6
Responsibilities For Lead, Claims Processor Resume
- Hiring Claims Processors at $15.75 per hour
- Hiring Claims Processors at $15.00 per hour
- Working Knowledge of Electronic Claims Submissions: Create and process electronic claims submissions and understand related software programs
- Submitting appeals/reconsideration to payers for incorrectly processed claims
- Working with Internal People to Help Our Dealers
7
Responsibilities For Ipmi Claims Processor Resume
- Hiring Claims Processors at $14 per hour
- Processing incoming claims
- Claims pre-processing, matching, batching, coding, and entering invoices
- Review and research assigned claims by navigating multiple computer systems and accurately capturing the data/information necessary for processing
- Ensure that the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g. claims processing policies and procedures, state mandates, CMS/Medicare guidelines, benefit plan documents)
- Reviews and researches assigned claims by navigating multiple computer screens, accurately capturing the data necessary for processing
- Review claims for correct provider coding information regarding appropriateness of reported services and billing practices
8
Responsibilities For Occupational Health Claims Processor Resume
- Follow up on all claims that are missing supporting documentation or pending authorizations in order to be processed
- Utilize an in depth understanding of billing and follow up regulations for electronic claims editing and submission
- Resolve and adjust claims, selecting from alternative methods deemed not solvable by adapting and interpreting policies and processes
- Data entry of claims into PCRS or ECS application for auto-pricing Manual pricing/handling of claims for retailers and their customers
- Manual pricing/handling of TPN claims for retailers and their customers
- Coordinate written notification to members, physicians and pharmacies following regulatory guidelines for claims that are missing information
9
Responsibilities For Claims Processor, Rcis Crop Claims Resume
- Assist when needed with the internal mail processes which includes batching and scanning of paper clams and attachments
- Assist supervision with establishing or revising published metrics
- Processes new claims or modifies existing claims according to the appropriate agency and/or action
- Working with CPT, ICD-9, HCPC and Revenue Coding
- Conduct weekly printing of client and provider pending letters and pre-determinations
- Thorough understanding of operational, fiscal and budgetary policies and practices within a government setting
- Knowledge of ICD-9 coding, CPT coding
- Analysis and processing of incoming claims, inclusive of all segments of claim
- Ensure proper coding for Engineer and Purchasing review
10
Responsibilities For Hospital Claims Processor Resume
- Assembles new claim files by gathering all necessary information and inputting information into the computer
- Audits and processes claims submissions following HP’s program/promotion guidelines
- Ensures training documentation associated to processes assigned is up to date and it’s accurate
- Data Entry - Perform accurate and efficient data entry using MS Access forms
- Enter dental claims into operating system
- Researches denied lines for appropriate resolution, answer telephone calls regarding questions on routine claims
- Monitor turn around times to ensure your claims are settled within required time scales, highlighting to team senior when this is not achievable
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