Almost all insurance companies hire a Claims Assistant to provide administrative and clerical staff. Apart from processing insurance claims, these assistants undertake all tasks that are mentioned on the Claims Assistant Resume – handling correspondence, taking phone calls, typing documents, ensuring the customer’s needs are met, assisting customers in filling their applications, gathering and organizing files, helping in auditing and mailing correspondence, providing general office and clerical assistance, reviewing bills, and executing all other duties as assigned.
It is recommended that the applicants have a thorough knowledge of using MS Office and relevant software to execute their jobs, the candidate should also show familiarity with the insurance industry, and they should be comfortable working with specific claims processing software. Candidates should possess fast typing skills as well. Eligible candidates should display on the resume an Associate’s degree in relevant areas.
Objective : Workers' Compensation Claims Assistant, Administrative Assistant, receptionist, data entry, word processing (Microsoft Word and light Excel), contract negotiator, some experience in accounting (accounts receivable and payable), filing, photocopying. Three years experience working retail sales with excellent customer service experience.
Skills : 10 Key Experience, Type 35 words per minute.
Description :
Assists in the processing of veterans claims by utilizing knowledge of Veterans Service Center filing procedures.
Plans, coordinates, and develops claims folders in cooperation with other government entities, such as Board of Veterans Appeals.
Analyze requests received for permanent and temporary transfer of folders, identifying and forwarding misdirected mail to the appropriate offices.
Serve as a liaison between mid-level and senior level management to ensure effective distribution of cases.
Examine claims folders on a continuing basis to eliminate and reduce misfiled folders, sorting and pulling active mail in an effort to keep files up to date.
Receives, disseminates, and tracks claims for review.
Establishing effective relationships at all levels to promote professionalism.
Ensure compliance with regulatory and statutory, laws, and regulations.
Experience
2-5 Years
Level
Executive
Education
Business Administration
Billing Claims Assistant Resume
Summary : Highly motivated Claims Assistant. Experienced in claim administration and management. Committed and motivated with exceptional customer-relations and decision-making skills. Professional demeanor and great initiative. Excellent team player. Poised and competent with demonstrated ability to adapt to fast paced and challenging environments.
Skills : Microsoft Office, Windows.
Description :
Support & interact with examiners, specialists, injured workers, employers, counsel, physicians and service providers.
Filed & served Stipulations, Settlements, medical reports, and letters to WCAB, attorneys and doctors.
Prepared file copies for Legal Referrals for defense attorneys.
Processed disability notices, lien objections, and medical correspondence letters.
Scheduled comprehensive medical appointments, interpreters, transportation, and mileage reimbursements.
Efficiently worked with staff nurses regarding medical status updates and recommendations.
Entered benefit compensation, service provider payments, and medical mileage payments in a timely manner.
Completed requests for subpoena of records, stop payments, check copies and re-issues.
Experience
7-10 Years
Level
Management
Education
AA In Liberal Arts
Sr. Claims Assistant Resume
Headline : Able to work well both as part of a team and independently - Can adapt to changing work environments - Able to learn and grow with constructive criticism - Detail-oriented - Experienced in customer service environment.
Skills : Microsoft office, Claim manager.
Description :
Examines a variety of claims to determine entitlement and appropriateness for payment of emergency room treatment, ambulance trips and non-VA hospital care as defined under the Millennium Health Care Act.
Develops claims under the Millennium Health Care Act; requesting information when required and presents to clinical liaison for final determination.
Ensures prompt payment of authorized ambulance, emergency room visits and emergent inpatient treatment as defined under the Millennium Health Care Act, in addition, emergency room visits and ambulance trips under fee basis guidelines.
Examines a variety of claims to determine entitlement and appropriateness for payment of authorized and unauthorized outpatient treatment; medications, and beneficiary travel for veterans.
Reviews, audits and processes claims/invoices (authorized and unauthorized) received from vendors and/or fee basis participants to insure information necessary for processing is present, contacts physicians, hospitals, pharmacies, veterans and their accredited representative to obtain supportive information for development of claims.
Downloads and processes claims that are received electronically under the Fee Payment Processing System (FPPS).
Extensive telephonic contacts with private sector physicians, veterans/beneficiaries and family members.
Experience
5-7 Years
Level
Consultant
Education
Master Of Science In Management
Medical Claims Assistant Resume
Objective : High level of autonomy and sense of personal responsibility in achieving success. Strong desire for expansion of current skillset in a fast-paced work environment. Punctual and highly reliable. Proficient in Microsoft Word, PowerPoint, Access, and Excel. Communicate effectively with a diverse clientele. Fluent in French. Experience in both team leadership and serving as a collaborative team member.
Skills : Customer Service, Management, Data Entry, Managment, Cashiering, Bar Coding, Menoring, Micorsoft Suite.
Description :
Assisting with workman's compensation claims for State of Illinois employees Sets up new claims in system and paper files, ensuring all documentation is recent and correct.
Prepares, schedules and processes benefit and medical payments on claim files as directed by the Claims Examiner.
Documents all work product and claim activity in the electronic claim file.
Prepares and prints letters, benefit notices and labels.
Provides clerical support, including filing, faxing, sorting, and alphabetizing.
May print and reconcile checks, as needed specific to branch office.
Communicates pertinent claim information to the client, legal counsel, medical and rehab providers and internal claims staff.
Answers phone calls, take messages and responds appropriately.
Experience
2-5 Years
Level
Executive
Education
Diploma
Dental Billing/Claims Assistant Resume
Headline : Responsible for Setting up indemnity claims, entering reserves on new claims and making initial payments in a timely manner, sending all benefit notices and issuing benefit payments to WC claimants.
Skills : Microsoft Word, Excel, PowerPoint, Outlook .. Typing 45+wpm .. Copy & Postage Machines .. Always willing to learn.
Description :
Assist Claims Examiners and Supervisors with the handling of Workers' Compensation (WC) claims.
In charge of writing and sending all settlement documents to the Workers' Compensation Appeals Board and Rehabilitation Unit for settlement.
Perform three-point contact to the insured, claimant and physician within twenty-four hours.
Claimant contact is done every thirty days on indemnity claims.
Physician contact is performed as needed to ensure timeliness of benefit payment.
Issue payment to venders for services rendered on the WC files.
Perform all aspects of setting up a claims file.
Experience
5-7 Years
Level
Executive
Education
Diploma
Claims Assistant/Adjuster Resume
Headline : Responsible for Assisting in the compilation of information on changes to policy, relevant plan provisions and applicable rules in order to produce correspondence.
Skills : Microsoft Office, Planning Skills.
Description :
Prepared and organized files for new claims.
Assisted the Claims department staff in updating and documenting claim files.
Assisted in processing transactions (opening reserves, closing, checks).
Performed follow up on claim handling by insurance companies.
Processed stop payments and fax police reports.
Provided the claims manager support services and maintained unit's claim files.
Coordinated claims process activities, for auditing functions - Set up and entered new claims into claims management system.
Experience
5-7 Years
Level
Consultant
Education
Diploma
Claims Assistant/Contract Resume
Objective : Well organized, dependable, and a reliable worker with a proven work history. Always willing to go above and beyond what is expected to meet or exceed expectations. Characterized as a logical, diligent, and thorough employee. Strengths include that I am experienced in customer support and project management. Work well in a team environment and can also work on my own.
Skills : Computer literate, 40wpm.
Description :
Provided information to vendors and patients on the status of their individual medical claims.
Provided claim status and respond to inquiries in a timely fashion.
Informed vendors and veterans of the Millennium Health Care Act and verify veteran eligibility status in the benefit program in regards to emergent care and non-emergent care.
Advised vendor of additional information needed by serving as a clinical liaison.
Provided payment information on paid claim status and advise of any discrepancy preventing completion.
Informed of appellate rights in regards to disputes for both vendors and patients.
Received and process mail for the scanning and uploading forms in the Fee Basis Claims System.
Assisted in the processing of filing all types of insurance claims for our customers.
Experience
2-5 Years
Level
Executive
Education
Business Administration
Claims Assistant III Resume
Summary : Seeking a position utilizing my extensive knowledge and successful experience in customer service, administration, claims handling, organizing, and following up multi-faceted, complex activities; and a position offering opportunities for personal contribution and professional growth.
Skills : Risk Management, MS Office.
Description :
Appointed as the first line of contact when a General Liability Claim was presented.
Responsible for answering and documenting telephone calls from Claimants, Plaintiff Attorneys, and Claim Adjusters.
Assisted the Senior Claims Manager with setting up new claims in the data base.
Analyzed the facts, secured pending information, and determined the liability.
Scheduled weekly telephone conferences with our insurance adjuster's and defense attorney's for status of pending claims; authorized the denial or settlement of claims.
Maintained a great rapport with claimants, attorneys, and adjusters.
Attended Small Claim hearings on behalf of the company; defended the company and/or settled with plaintiff.
Ensured the Motor Vehicle Reports adhered to company policies for new drivers.
Experience
10+ Years
Level
Senior
Education
Business Management
Claims Assistant Resume
Headline : A dedicated Claims Assistant professional with a background in multiple industries. Skilled in prioritizing and planning work loads by being detail oriented. Great at multitasking and has strong organization skills. Well-developed communication and problem-solving skills with the ability to resolve difficult situations under adverse conditions. Good at working in a fast paced environment. Experienced with various computer software programs.
Skills : Data Entry, Accounts Payable, Accounts Receivable,.
Description :
Preparing letters and issuing total temporary disability benefit payments.
Prepared file and serve letters, and responded to subpoenas by contacting the applicant attorneys and defense attorneys representing the claim.
Made determinations to accept, delay, or deny claims based upon valid medical, factual, or statutory reasons.
Determined probable monetary value of cases and assigned appropriate reserves; and reviewed reserves regularly to ensure adequacy.
Ensured payment of benefits in accordance to California Labor Code, ACOEM Guidelines, Administrative Rules and Regulations, and departmental policies and procedures.
Tracked injured employees' progress on returning to work after absence.
Reported associated lost days and modified days to employee supervisor and claims administration.
Experience
5-7 Years
Level
Consultant
Education
Business Administration
Claims Assistant Resume
Headline : Claims Assistant excelling at customer satisfaction and problem resolution. Working history of billing, accounts receivables, and collections. Ability to remain calm in stressful situations. Efficient and orderly, able to work independently and exercise good judgement without close supervision. Superior People Skills Meticulous Attention to Detail Friendly - Enthusiastic Focused on Customer Satisfaction Dependable Highly Motivated Integrity - Work Ethic Skilled Multi-Tasker.
Setup new Worker's Compensation claims by entering into database and creating hard file.
Scan paper documents to be stored as well as maintaining paper files.
Provide high level of customer service via telephone and email to clients and participants.
Send electronic files to the State Board of Insurance to insure reporting compliance.
Process payments for claim expenses including lawyer fees, medical bills, etc.
Act as receptionist for Worker's Compensation calls from participants and clients.
Created and maintained complex filing system for large volume of information.
Experience
5-7 Years
Level
Consultant
Education
Diploma
Claims Assistant Resume
Objective : As a Claims Assistant, responsible for Handling telephone inquiries of moderate technical nature to assist callers using the claim system, Entering details of conversation into the claim system to document calls, and also Directing highly technical, non-routine calls to adjusters or manager.
Skills : Microsoft Office, excel, lotus notes, bilingual, and communication skills.
Description :
Screened, reviewed and identified potentially eligible foster youth to be processed for SSI & RSDI/Title II benefits in our City of New York, Administration for Children Services (ACS).
Uploaded/tracked required SSI & RSDI/Title II information and managing related data.
Served as the primary contact for all team and client correspondence.
Facilitated communication between key stakeholders.
Compiled documents, including the drafting of correspondence and training protocols.
Assisted in the monthly preparation and submission of performance reports.
Ensured the protection of confidential materials.
Maintained knowledge of ACS practices and policy changes related to SSI & RSDI/Title II benefits.
Experience
2-5 Years
Level
Executive
Education
Psychology
Claims Assistant/Scheduler Resume
Objective : Acknowledged throughout career for dispensing personalized attention, maintaining composure under fire, and juggling a multitude of job tasks and challenges with skilled discretion and concern. Refined capabilities in researching customer issues, providing clear and accurate responses, and adapting to suit the situation.
Skills : Problem Solving, Negotiating Settlements, Negotiating Settlements, Setting Up Training, Customer Service Skills, Investigating Liability, Microsoft Office.
Description :
Created letters based off of the property, auto, and surety claims adjusters request.
Ran reports once the claims were filed to insure the claim was not a duplicate or insurance fraud.
When a vehicle was a total loss and the title came in, I would send the title to the yard so the vehicle could be sold.
Scanned documents into the systems to be attached at a later time.
Delivered mailed to other claims assistants.
Reviewed spreadsheets to make sure glass claims were closed correctly.
Assist in bill payment process, and data entry task and documentation production.
Experience
2-5 Years
Level
Executive
Education
Master's
Sr. Claims Assistant Resume
Objective : Claims Assistant is responsible for the claims process, including claims data entry, claim management, and claim analytics. The claims assistant is also responsible for developing and authoring all process documentation.
Skills : Emergency Medical Technician, Physical Security, Force Protection, Intelligence Collection, Analyzing And Dissemination, Law Enforcement, Working Dogs.
Description :
Serve as the initial reviewers for compensation and pension claims.
Responsible for the care and maintenance of the claims folders, analyzing the claim, and determining if the disposition of the claims and control action have been appropriately identified.
Develop straightforward evidence in conjunction with claims, establish or update control action, and facilitate workflow between the team and other Veterans Service Centers (VSC).
Ensures that claims are processed so Veterans receive the benefits they have earned through their service.
Provided high quality customer service by determining the best approach for each individual customer.
Inputted all updates into databases while processing claims applications and associated paperwork.
Used personnel time to keep Veterans up to date with the most current information on all Benefits, and privileges offered under the body of the Federal law.
Experience
2-5 Years
Level
Executive
Education
Information Technology
Claims Assistant/Vendors Resume
Objective : Responsible for Providing basic information to insureds/claimants regarding liability and coverage from reading and interpreting file notes to provide an update on the claims process and on that individual's claim.
Skills : Microsoft Office, Analytics, Time Management, Multi-Line Phone System, Multi-tasking, Detail Oriented.
Description :
Provides administrative and clerical support to the claimant representatives.
Responsible for the process and accuracy of SSA forms.
Responsible for a wide range of job dutiesfrom talking with customers on the telephone to copying, typing/keyboarding, and filing.
Performs vital data entry into the Case Management system as cases progressesthrough the disability process.
Document thoroughly and accurately the Notes database with any information related to the claim.
Sets the appropriate next action step for the disability claim.
Submits the disability formsto be forwarded to the claimants, Social Security, and Disability Determination Services.
Prepares and selects the correct letters to be forwarded with these forms.
Experience
2-5 Years
Level
Executive
Education
Pharmacy Technician
Claims Assistant Resume
Summary : As a Claims Assistant, responsible for Assisting in the preparation of standard correspondence to policy holders and customers, as directed, Using form letters and other tools to respond to routine inquiries.
Skills : Microsoft Office, Customer Service, Computer Repair, Data Entry, Inventory Management.
Description :
Under technical direction, works within significant limits and authority on new medical only claims.
Responsible for claims management of assigned cases within guidelines of published performance standards.
Issue medical payments according to set procedures and working with examiners with reserving.
Issue disability payments within given authority.
Input and monitor automatic disability schedule payments and cancellations.
Perform electronic investigation relating to background checks, other reported injuries and death records searches.
Perform other clerical duties as assigned such as filing, sorting, requesting of records, mailing of records.
Completing reimbursement requests either through a 3rd party or filing directly with the State.
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