Medical Claims Analyst Resume Sample
Work Experience
- Demonstrate Company’s Core Competencies and values held within
- Review submitted claim documents for sufficient data, verifies that benefits were paid correctly and in accordance with appropriate plans and policies
- Responsible for documenting and tracking results in designated format and timeframes
- Assist manager in identifying trends, weaknesses, and strengths for insight to the team's quality and understanding of the work. Includes developing training materials, and conducting training sessions with staff
- Assist supervisor with system procedures relating to adjustments, voids, cancellations, or reimbursements. Communicate with Accounting regarding: returned claims checks - due to wrong address info; as requested by the Claims department; or as submitted due to provider corrections
- Recommend changes to the Claims Procedural manual. Update manual as necessary with changes
- Verify quality assurance and prepare claim files for submission
- Sorting and filing claims and errors in an organized manner
- Computer savvy—creating, moving, submitting files and folders
- Tracking errors to sure all claims are corrected and sent out
- Clearinghouse: Upload claim files, retrieve and verify daily and payor reports
- Troubleshoot software error reports, clearinghouse rejections, etc
- Meticulous record keeping including electronic claim files
- Research, identify and obtain data / information needed to help accurately interpret the data as needed
- Medical claims adjudication and / or medical claim customer service experience with exposure to Coordination of Benefit (COB) and / or interpretation of Explanation of Benefits (EOB)
- Data analysis experience (finding trends in data including plans, products and network rate differentials)
Education
Professional Skills
- Effective communications, organizational, and interpersonal skills
- Two to three years medical claims processing and adjustment experience required
- Medical claims processing and adjustment experience; required
- Experience managing deadlines
- Navigate within computer system environments without assistance; previous experience in a windows-based computer environment
- Experience at a medical insurance company; required
- Proficient with Microsoft Excel (basic formulas, sorting, filtering and formatting)
How to write Medical Claims Analyst Resume
Medical Claims Analyst role is responsible for insurance, software, training, basic, analysis, coding, benefits, accounting, diplomacy, microsoft.
To write great resume for medical claims analyst job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Medical Claims Analyst Resume
The section contact information is important in your medical claims analyst 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 Medical Claims Analyst Resume
The section work experience is an essential part of your medical claims analyst 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 medical claims analyst responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular medical claims analyst position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Education on a Medical Claims Analyst Resume
Make sure to make education a priority on your medical claims analyst resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your medical claims analyst 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 Medical Claims Analyst Resume
When listing skills on your medical claims analyst 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 medical claims analyst skills:
- Medical coding, billing, CPT Codes
- Knowledge of UNET / NDB, iDRS / EDSS and / or ppoONE
- 6+ months Access
- 6+ months Excel