Claims Processor Resume
Objective : Results-oriented Claims Processor with 2 years of expertise in evaluating and processing insurance claims efficiently. Proficient in analyzing documentation, ensuring compliance with policy guidelines, and delivering exceptional customer support. Committed to optimizing claim resolutions while maintaining high-quality standards and fostering positive relationships with clients and stakeholders.
Skills : Claims Processing Software, Data Analysis Techniques, Document Management Systems, Client Communication Tools
Description :
- Reviewed claims from project lists and work queues, ensuring adherence to quality standards for suspended claims.
- Worked in a high-production environment, prioritizing quality outcomes in claims processing.
- Adjudicated medical claims in compliance with CMS guidelines and internal policies.
- Collaborated with various departments to gather essential information for effective claim resolution.
- Provided timely support to members, providers, and billing departments regarding claims and eligibility inquiries.
- Coordinated benefits while accurately applying deductibles and co-insurance calculations.
- Distributed pending claims among the team for efficient resolution and reassignment.
Experience
0-2 Years
Level
Entry Level
Education
AASBA
Medicare Claims Processor Resume
Objective : Dedicated Medicare Claims Processor with over 5 years of experience in efficiently evaluating and processing medical claims. Skilled in interpreting regulations, ensuring compliance, and delivering superior customer service. Adept at managing complex claims and fostering relationships with clients and providers to optimize resolution outcomes.
Skills : Claim Processing Efficiency, Regulatory Compliance, Client Relationship Management, Analytical Problem Solving, Problem Solving
Description :
- Processed and evaluated Medicare claims with a focus on accuracy and compliance with federal regulations.
- Reviewed documentation to ensure adherence to policy guidelines and identified discrepancies.
- Communicated effectively with clients and healthcare providers to resolve inquiries and issues.
- Maintained meticulous records of claims and documented all interactions for transparency.
- Utilized medical billing knowledge to determine claim eligibility and payment approvals.
- Provided training and support to junior staff on best practices in claims processing.
- Monitored claim statuses and followed up on outstanding issues to ensure timely resolutions.
Experience
2-5 Years
Level
Junior
Education
B.S. Health Admin.
Claims Processor Resume
Objective : Driven Claims Processor with 2 years of experience in managing and resolving insurance claims. Skilled in analyzing documentation for accuracy, ensuring compliance with regulations, and providing exceptional service to clients. Passionate about enhancing claim processes and building strong relationships with stakeholders to achieve optimal outcomes.
Skills : Claims Analysis, Customer Service Excellence, Claims Compliance Management, Data Entry And Management, Client Relations, Negotiation Skills
Description :
- Interpreted insurance contracts to ensure accurate billing and compliance.
- Processed refunds and rejections of claims, generating weekly and monthly performance reports.
- Reviewed patient accounts, implementing solutions to achieve zero balances through thorough research.
- Monitored inventory and provided weekly updates, ensuring operational efficiency.
- Established and maintained strong relationships with provider partners and payer clients.
Experience
0-2 Years
Level
Entry Level
Education
AAS
Claims Examiner Resume
Objective : Accomplished Claims Examiner with 2 years of experience in evaluating and processing insurance claims. Adept at conducting thorough documentation reviews and ensuring compliance with industry regulations. Focused on delivering exceptional service and fostering strong client relationships to enhance claim resolution efficiency.
Skills : Claims Management, Time Management, Communication Skills, Claims Review, Analytical Skills, Attention To Detail
Description :
- Assisted clients in completing applications for state and federal benefit programs to expedite hospital bill approvals.
- Processed claims applications within designated turnaround times, ensuring timely resolution.
- Accurately entered patient demographics and financial proof into claims management software.
- Organized and prepared paperwork for submission to various agencies, enhancing workflow efficiency.
- Drafted and submitted disability applications to the Social Security office, ensuring compliance with guidelines.
- Maintained effective communication with co-workers, patients, and families from diverse backgrounds.
- Provided administrative support to management, including processing mail and adhering to all HIPAA regulations.
Experience
0-2 Years
Level
Entry Level
Education
B.S. in BA
Claims Processor Resume
Objective : Dedicated Claims Processor with 5 years of experience in efficiently managing insurance claims. Expertise in meticulous documentation review, compliance verification, and delivering outstanding customer service. Proven ability to navigate complex claims scenarios while ensuring timely and accurate resolutions.
Skills : Critical Thinking, Record Keeping, Policy Interpretation, Claims Management Software, Documentation Review, Customer Communication
Description :
- Managed the sorting and scanning of incoming claims documentation, ensuring accurate filing.
- Conducted comprehensive reviews of claims to identify and address missing or incomplete information.
- Applied extensive knowledge of medical terminology to assess and interpret medical documents accurately.
- Processed new and modified insurance policies, verifying the accuracy of claims and account details.
- Oversaw the preparation and dispatch of all outgoing mail related to claims processing.
- Engaged with healthcare providers and clients to resolve issues related to claims promptly.
- Maintained clear communication with stakeholders regarding claim status and updates.
Experience
2-5 Years
Level
Junior
Education
A.S. in BA
Motor Vehicle Claims Processor Resume
Objective : Accomplished Claims Processor with two years of dedicated experience in assessing and processing motor vehicle claims. Proven ability to analyze documentation for accuracy, ensure compliance with guidelines, and provide outstanding customer service. Eager to leverage expertise in claims resolution and client engagement to contribute to an efficient claims processing team.
Skills : Microsoft Office Suite, Email Communication, Data Management, Data Analysis
Description :
- Organized and processed complex auto claims in a high-volume environment, ensuring accuracy and compliance.
- Applied claims settlement procedures to initiate payments and manage reserve requirements.
- Communicated effectively with policyholders, claimants, and witnesses to gather essential facts for claim resolution.
- Identified claims needing specialized handling and coordinated with independent experts as required.
- Managed claim files, scheduled vehicle inspections, and coordinated rental vehicle arrangements.
- Negotiated settlements, processed total loss payouts, and ensured proper documentation for vehicle branding.
- Compiled statistical data on tire and wheel claims to prepare comprehensive reports.
Experience
0-2 Years
Level
Entry Level
Education
AAS in BA
Claims Processor Resume
Objective : Accomplished Claims Processor with 5 years of extensive experience in processing diverse insurance claims. Demonstrates exceptional analytical skills in documentation review and compliance verification while providing top-tier customer service. Committed to fostering strong relationships with clients and stakeholders to ensure timely and effective claim resolutions.
Skills : Bilingual Communication, Multi-channel Communication, Effective Time Management, Microsoft Word Proficiency, Microsoft Excel Expertise, Research Skills
Description :
- Processed a variety of insurance claims, including medical, workers' compensation, auto, and disability claims, ensuring compliance with company policies.
- Collaborated with adjusters to address and resolve escalated payment issues efficiently.
- Verified and approved claim payments, ensuring accuracy and adherence to regulatory standards.
- Provided expert assistance to clients and adjusters regarding claims status and inquiries.
- Ensured compliance with state tax laws related to applicable claims.
- Conducted thorough reviews of documentation to facilitate timely claims processing.
- Communicated effectively with providers to obtain necessary information for claims resolution.
Experience
2-5 Years
Level
Junior
Education
B.S.B.A.
Claims Processor Associate Resume
Objective : Detail-oriented Claims Processor with 2 years of experience in efficiently managing and resolving insurance claims. Expertise in analyzing documentation for compliance, enhancing claim processes, and delivering excellent customer service. Eager to contribute to a dynamic team by leveraging strong analytical skills and a commitment to client satisfaction.
Skills : Claims Documentation Software, Claims Presentation Tools, Data Analysis And Reporting, Claims Research Tools, Data Entry Skills, Organizational Skills
Description :
- Managed incoming inquiries by phone and correspondence, ensuring timely responses.
- Identified and corrected incorrectly processed claims, executing adjustments.
- Determined claim status based on organizational policies, ensuring compliance.
- Handled confidential information with discretion while utilizing Microsoft Office.
- Researched disputed claims to assist in liability decisions effectively.
- Resolved customer issues related to claim settlements, including rentals and payments.
- Prepared and reviewed insurance claim forms for completeness and accuracy.
Experience
0-2 Years
Level
Entry Level
Education
AAS
Claims Processor Resume
Headline : Proficient Claims Processor with 7 years of experience in evaluating and resolving insurance claims. Excels in documentation analysis, compliance verification, and delivering exceptional client service. Demonstrated ability to streamline claims processes and enhance operational efficiency while maintaining strong relationships with stakeholders.
Skills : Quality Assurance, Insurance Claims Management, Claims Documentation Review, Technical Proficiency, Conflict Resolution
Description :
- Handled incoming claims notifications, ensuring accurate entry into the claims system for proper routing.
- Processed claim payments and managed documentation to close claims efficiently.
- Maintained quality standards by addressing suspended claims daily to meet departmental goals.
- Managed personal inventory of claims, consistently achieving daily processing quotas.
- Cross-trained in total loss assessments, determining values and issuing settlement checks.
- Conducted investigations and analyzed outcomes to make informed liability decisions.
- Collaborated with team members to enhance claims processing workflows and improve service delivery.
Experience
5-7 Years
Level
Senior
Education
B.S. in BA
Auto Claims Processor Resume
Headline : Dynamic Auto Claims Processor with 7 years of extensive experience in managing and resolving complex insurance claims. Expert in documentation analysis, compliance assurance, and delivering exceptional customer service. Proven ability to enhance operational efficiency and foster strong relationships with clients and stakeholders, ensuring timely and effective claim resolutions.
Skills : Claims Processing, Claim Investigation, Statistical Analysis, Time Tracking
Description :
- Reviewed and processed insurance claims for accuracy and compliance with company policies.
- Collaborated with attorneys, witnesses, and repair shops to investigate, negotiate, and resolve claims effectively.
- Evaluated claim documentation to determine eligibility and coverage limits.
- Processed and meticulously filed claims, ensuring accuracy and confidentiality.
- Utilized strong communication skills to build and maintain relationships with clients.
- Exceeded performance targets, consistently ranking among the top ten processors in the department.
- Analyzed complex claims data to identify trends and recommend process improvements.
Experience
5-7 Years
Level
Senior
Education
B.S. in BA
Auto Claims Processor Resume
Objective : With 5 years of experience in auto claims processing, I excel in evaluating and resolving claims while ensuring compliance with industry standards. My strong analytical skills and commitment to customer satisfaction enable me to streamline processes and foster positive relationships with clients. I am dedicated to optimizing claim outcomes and enhancing operational efficiency within the claims department.
Skills : Multi-tasking, Adaptability, Report Generation, Database Management, Fraud Detection
Description :
- Engaged with clients daily to assess their policy needs and clarify coverage details.
- Provided tailored recommendations to meet client-specific requirements.
- Served as a liaison for rental procedures, addressing and resolving rental issues effectively.
- Updated team members on procedural changes to ensure seamless implementation.
- Led subrogation efforts, aligning team goals with corporate fund management objectives.
- Maintained strong vendor relationships, facilitating effective claims processing.
- Handled claims across multiple states, ensuring compliance with local regulations.
Experience
2-5 Years
Level
Junior
Education
BBA
Auto Claims Processor Resume
Objective : A detail-oriented Auto Claims Processor with 2 years of experience in efficiently managing insurance claims. Skilled in evaluating documentation, ensuring compliance with policies, and providing exceptional customer service. Passionate about streamlining claim processes and building strong relationships to enhance resolution outcomes.
Skills : Claims Training And Support, Claims Process Improvement, Insurance Customer Relations, Client Engagement Strategies, Data Entry, Follow-up Skills
Description :
- Managed auto claims across 6 states, ensuring adherence to company policies and state regulations.
- Coordinated vehicle inspections and repairs with body shops to expedite claim resolutions.
- Consistently handled the highest volume of calls in the team, demonstrating strong communication skills.
- Trained new hires on claims processing procedures and best practices.
- Reviewed insurance policy terms to confirm coverage for claims submitted.
- Evaluated claims from insured parties and third parties to determine liability.
- Processed claims assigned by the claims management system, ensuring timely updates and resolutions.
Experience
0-2 Years
Level
Entry Level
Education
AABA
Auto Claims Processor Resume
Objective : Experienced Auto Claims Processor with 5 years in evaluating and resolving insurance claims. Demonstrates expertise in documentation analysis, ensuring compliance, and delivering outstanding customer service. Passionate about optimizing claim processes and enhancing client relationships to achieve efficient resolutions.
Skills : Payment Processing, Claims Compliance Verification, Workflow Optimization, Process Improvement, Financial Acumen, Customer Advocacy
Description :
- Managed incoming calls for auto claims, providing timely assistance to clients.
- Trained new hires on claims processing protocols and customer service best practices.
- Collaborated with team members to resolve low complexity auto claims through effective communication.
- Maintained high production levels while ensuring quality documentation and customer focus.
- Served as Subrogation Team Captain, leading efforts to recover costs from liable third parties.
- Consistently exceeded performance metrics for call handling and claims accuracy.
- Engaged in continuous training to stay updated on industry regulations and claims processing software.
Experience
2-5 Years
Level
Junior
Education
B.S. in Business Admin
