Claims Rep Resume Sample
Garnet West
9289 Heaney Ports,
Chicago,
IL
+1 (555) 888 7288
Work Experience
Senior Work Comp Claims Rep
02/2016
-
PRESENT
Phoenix, AZ
- Has the authority to make payment of assigned claims within prescribed limits, with supervisory review and approval
- Inspects damaged property and vehicles, and determines claims related damage
- Personal contacts are a major part of activity and include policyholders, claimants, agents, witnesses, repair facilities, contractors, police and fire departments, state and county fraud and arson personnel, special investigators, attorneys, expert witnesses, members of the medical profession and all other persons’ incident to the investigation and processing of claims
- Reviews and processes all contracted capitated claims and fee-for-service PCP administration fee for-service claims paid and or denied while achieving and maintaining a 95% accuracy rate. 25%
- Reviews and processes claims acknowledgment, payment and denial as set forth by CMS, Healthplans and departmental policy and procedures while achieving and maintaining a 95% timeliness standards. 25%
- Achieving and maintain 95% production requirements per claim type utilizing departmental policy and procedures as established per Healthplan and Network. 20%
- Recognizes inappropriate CPT, ICD-9 and HCPCS codes and accurately research member eligibility, duplicate claims submissions, out of network services, out of area services and COB and adjudicate according to departmental procedures. 15%
- Monitors and updates inventory reports in order to track claims in inventory and follows-up on all claims suspended for review purposes or additional information requests until claims are in a final status. 5%
Claims Rep
09/2010
-
10/2015
Houston, TX
- Reviews and processes audit errors on a daily basis. 5%
- Alerts Claims Management of all claims issues that would impact any Healthplan compliance. 5%
- Contacts with interested parties are made primarily through written and telephone communication
- Proficiency with computer operation and web based applications, Microsoft Office proficiency,
- Strong organizational skills, strong oral and written communication skills and strong negotiation skills
- Interact with customer, branch operations, and other Brink’s partners to effectively process claims
- Possess basic analytical and problem solving skills
Subrogation Claims Rep
05/2006
-
07/2010
Philadelphia, PA
- Responds to incoming calls from members and providers
- Responsible for pulling explanation of benefits for the department
- Assists with formal training needs of new employees as needed
- Conducts member satisfaction assessment services as applicable and based on business needs
- Processes Check Tracers requests for the department
- Proficiency with smartphones and applications
- Workers’ compensation claim handling with experience handling California claims
- Excellent listening, verbal and written communication skills. Ability to multi-task and adapt to a changing environment
Education
Indiana Wesleyan University - Kokomo Campus
2000 - 2005
Bachelor's Degree in Computer
Professional Skills
- Experience prior experience as a Claims Examiner in an IPA, Medical Group or Health Plan
- Proficiency in general computer skills needed
- Claims experience (ICD, Coding, Billing, etc.)
- Call/Contact center experience (Inbound/Outbound)
- 6 - 12 months of related experience
- Typing speed of 35-40 WPM
- Handle new Auto Bodily Injury Claims (including determining coverage, investigation and evaluation)
How to write Claims Rep Resume
Claims Rep role is responsible for travel, insurance, compensation, general, negotiation, organization, investigation, education, commercial, typing.
To write great resume for claims rep job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Claims Rep Resume
The section contact information is important in your claims rep 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 Rep Resume
The section work experience is an essential part of your claims rep 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 rep 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 rep position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Education on a Claims Rep Resume
Make sure to make education a priority on your claims rep resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your claims rep 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 Rep Resume
When listing skills on your claims rep 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 rep skills:
- Familiarity with computerized claims processing/transaction system
- Handle a pending of Auto Bodily Injury Claims
- Texas Adjusters license required
- Navigate multiple computer screens
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