Medical Claims Examiner Resume Samples

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Guide the recruiter to the conclusion that you are the best candidate for the medical claims examiner job. It’s actually very simple. Tailor your resume by picking relevant responsibilities from the examples below and then add your accomplishments. This way, you can position yourself in the best way to get hired.

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B Pagac

Breana

Pagac

7187 Ignacio Union

Dallas

+1 (555) 511 4542

7187 Ignacio Union

Dallas

Phone

p +1 (555) 511 4542

Experience Experience

Detroit, MI

Medical Claims Examiner

Detroit, MI

Schuppe, O'Keefe and Romaguera

Detroit, MI

Medical Claims Examiner

We have opportunities for work-at-home, local and travel assignments
We have a variety of work-at-home opportunities, travel assignments and some local positions
Timely and accurate adjudication of all types of claims from assigned workflow queues
Effectively communicates with members and providers verbally and in writing regarding claim issues including claim adjudication, subrogation, and overpayments or billing problems
Demonstrate a thorough knowledge of the Plan's claims processing procedures as provided in training materials and proficiency with the core and ancillary system applications
Performance standards of 15 claims/hour with 97% or above financial and procedural quality & accuracy rates
Report to work during core business hours (8:00 a.m. – 5:00 p.m.) on a consistent, regular basis

present

Chicago, IL

Medical Claims Examiner

Chicago, IL

Moore Group

present

Chicago, IL

Medical Claims Examiner

present

Accurate and timely review of claim pricing to facilitate manual pricing as necessary, working with various Health Plan provider networks
Work with members of staff on identifying process improvements
Provide written correspondence and verbal information to members, group contacts, agents, and healthcare providers
Perform other duties as assigned by management
Perform necessary check run process and communicate check register information
During travel, a weekly per-diem is provided but not while on rotations home
Actively participates and supports department and organization-wide efforts to improve efficiencies while supporting departmental goals and objectives

Education Education

Bachelor’s Degree

University of California, Los Angeles

Bachelor’s Degree

Skills Skills

Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures or government regulations
Knowledge of Medical Terminology and knowledge of ICD-10 and CPT Codes
Detail-oriented
Strong project management skills, including thorough and complete follow-up to all time-sensitive items
Ability to effectively present information and respond to questions from groups of managers, customers and general public
Excellent written and verbal communication skills
Excellent interpersonal skills
Excellent time management
Strong customer service focus
Internet savvy and proficient with Microsoft Word, Outlook, Excel

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Medical Claims Examiner Resume Examples & Samples

We have a variety of work-at-home opportunities, travel assignments and some local positions
THIS will be a work-at-home assignment requiring high speed internet services (non-refundable) and we provide a PC for the duration of the project
Our travel assignments are located nationwide and may require 100% travel with rotations home every 6-8wks depending on the client requirement
Travel includes your hourly wage, $245/week per diem (paid each Friday ~ no receipts needed, this is yours free and clear), and all travel/hotel/rental car expenses covered in full up front (no out of pocket to you)
Occasionally, we have local assignments that would be within 50 miles of your residence

Medical Claims Examiner Resume Examples & Samples

We have opportunities for work-at-home, local and travel assignments
Our work-at-home assignments require high speed internet services (non-refundable) and we provide a PC or laptop for the duration of your project
During travel, a weekly per-diem is provided but not while on rotations home
Local positions would be considered within 50 miles of where you live
As a Dell Associate, you will have access to benefits and retirement plans on the first start day of employment

Medical Claims Examiner Resume Examples & Samples

Actively participates and supports department and organization-wide efforts to improve efficiencies while supporting departmental goals and objectives
1 year experience with insurance claims in a health insurance setting or healthcare setting
1 year demonstrated experience in managed care for HMO, PPO, Medicare, Medicaid, etc

Medical Claims Examiner Resume Examples & Samples

Report to work during core business hours (8:00 a.m. – 5:00 p.m.) on a consistent, regular basis
Process medical and/or dental claims, as well as disability, pharmacy, flexible spending, or vision claims, if applicable
Interpret and apply specific plan document language as well as determine eligibility for benefits during claims adjudication
Provide written correspondence and verbal information to members, group contacts, agents, and healthcare providers
Refer potential abuse, subrogation, and adjustment claims
Perform necessary check run process and communicate check register information
Provide responsive and professional customer service for assigned groups as well as other groups with Client as needed
Work with members of staff on identifying process improvements
Flexibility to work overtime as dictated by department/company needs
Perform other duties as assigned by management
1-2 years previous experience required
Experience in and knowledge of self-funded employee benefits with an emphasis in client management
Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures or government regulations
Effective business correspondence skills, including prompt and detail-accurate follow-up
Strong project management skills, including thorough and complete follow-up to all time-sensitive items
Ability to effectively present information and respond to questions from groups of managers, customers and general public
Mathematic and reasoning skills, including practical problem solving that includes fractions, percentages, ratios, proportions, diagrams and schedules
Commitment to a team-oriented office environment
Internet savvy and proficient with Microsoft Word, Outlook, Excel
Licensed insurance agent/broker
Required attributes
Self-managed, autonomous
Problem solver
Service-driven
Excellent communication

Medical Claims Examiner Resume Examples & Samples

Research, analyze and authorize payment or denial on claims for medical services
Correctly adjudicate a high volume of claims daily
Working from various reports to reduce claim inventory and to improve timeliness
Create letters for inquiry or response to members and clients
Correspond with clients, providers, TPAs, and other entities as needed to finalize claim payment and resolve inquiries
Process claims for flexible spending accounts
Handle confidential or sensitive information with discretion
Ensure legal compliance by following company policies, procedures, guidelines, as well as state and federal insurance regulations
Thoroughly document medical claims actions (especially unique actions) by completing forms, reports, logs or records and via system documentation methods
Perform an expanding range of assignments while becoming increasingly capable of navigating through the claims system and using all claims processing systems
Any additional duties, as assigned by management

Medical Claims Examiner Resume Examples & Samples

Typically requires 3-5 years general administrative experience, or equivalent combination of experience in the medical healthcare arena
Intermediate to senior level administrative knowledge and skills
Has the ability to work with multiple issues/projects and people
May be regarded as an “leader”
Specific advanced level of software skills as required by the work unit
Knowledge of Medical Terminology and knowledge of ICD-10 and CPT Codes
Knowledge of Healthcare Claims processing policies and procedures

Medical Claims Examiner Resume Examples & Samples

Solid computer, grammar and multi-tasking skills
Strong attention to detail, time management
Independent decision-making
Demonstrated job stability

Medical Claims Examiner Resume Examples & Samples

Clear and concise written and verbal communication skills
Strong problem-solving and analytical skills
Dependable and flexible

Medical Claims Examiner Resume Examples & Samples

Ability to prioritize and juggle multiple tasks simultaneously
Effective communicator both orally and in writing
Familiarity with workers compensation medical terminology
1 Year

Medical Claims Examiner Resume Examples & Samples

Document all incoming medical reports
Contact the employer to confirm no lost time and no red flags
Review the medical reports for accuracy and consistency in relation to the employers report and the original body part that was injured
Review claims every 30 to 45 days to ensure file progression
Authorize medical treatment, physical therapy and medications as needed
1 Year of experience handling Medical Only claims & Future Medical claims

Medical Claims Examiner Resume Examples & Samples

Education: Bachelor’s degree OR 4 years of additional experience in lieu of degree
Experience: 2 years of experience
Licenses/Certifications: Independent Adjuster’s License
Previous experience in workers compensation insurance industry preferably as a Claims Adjuster, Claims Analyst, or Claims Examiner with full knowledge of investigation and administration of claims
Six plus years of direct experience

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