Claims Processor Specialist Resume
Objective : Dedicated insurance professional with more than 5 years of experience in claims processing, research, billing, and adjustments. Excel in analyzing account problem areas and its root causes, interpreting policies and processing case-sensitive decisions. Effectively manage high-priority projects and take pride in providing exemplary customer service.
Skills : Microsoft Word, Microsoft Excel, Adobe, Microsoft Outlook
Description :
- Reviewing claims working off project list or work queue. Maintain quality standards responsible to work suspended claims on a daily basis.
- Experience in a production based environment with an emphasis on quality outcomes.
- Reviewing and adjudicating medical claims in accordance with cms claim processing guidelines.
- Interface with other departments to obtain necessary information required for resolution of claims.
- Provided prompt customer support to members, providers, billing departments and other insurance agency's regarding claims, appeals and eligibility.
- Coordinated benefits while applying applicable deductibles, co-insurance and out of pocket costs.
- Evenly distributed pending spreadsheet amongst team to quickly focus on the closure or reassignment of claims.
Experience
2-5 Years
Level
Executive
Education
BS Management
Medicare Claims Processor Resume
Objective : Insurance Claims Processor - Medical Claims Dedicated insurance professional with more than 6 years of experience investigating and processing insurance claims. Excel in analyzing diagnosis, procedures/causes, interpreting policies and negotiating payment solutions. Effectively manage multiple, high-priority projects and take pride in providing exemplary customer service.
Skills : Communication, Multitasking, Prioritizing, Organization, Technical, Interpersonal, Problem-solving Abilities, Dependability.
Description :
- Balance multiple tasks including call handling, loan level review and call documentation within required metrics.
- Gather and track information and troubleshoot client/customer inquiries and problems.
- Research/resolve loan level inquires as it relates to inbound/outbound call activity.
- Follow standard policies and procedures for resolving problems and responding to the customer in a timely manner.
- Recognize consistent problem areas and report to a higher level for action.
- Build and maintain effective internal working relationships and support teamwork in meeting company goals.
Responsible for providing expertise and general claims support to the department by processing incoming/outgoing mail.Utilize resources and prior experience in medical billing to determine if claims should be approved for payment or denied.
Experience
2-5 Years
Level
Executive
Education
Diploma
Claims Processor Specialist Resume
Objective : Seeking a permanent and challenging position that matches my ambitious and motivated personality and uses my extensive experience to exceed professional expectations.
Skills : Microsoft Office, Healthcare Insurance, Office Administration, Supervisor, SCADA Systems
Description :
- Interpreted contracts with payers to ensure proper payment, sending initial or secondary bills to insurance companies.
- Process refunds/reinstatements/ rejections of insurance claims, running reports on a weekly and monthly basis.
- Reviewed patient accounts and resolved them to a zero balance by researching, and investigating all outcomes.
- Kept track of the inventory by reporting and sending weekly updates planned, prioritized, organized and completed work to meet established production goals or quotas.
- Created and maintained business relationships with our provider partners and payer clients.
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Resolved customers issues in regards to the settlement of claims not limited to arranging rentals, and payment for damage.
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Research disputed claims on callers behalf to assist in liability decision.
Experience
0-2 Years
Level
Entry Level
Education
Associate of Science
Claims Processor I Resume
Objective : To secure a position that will enable me to use my strong organizational skills, customer service background, and ability to work well with people in order to make a positive contribution to the company.
Skills : Project Management, Management/Leadership, Accounting, Microsoft Office
Description :
- Assisted indigent clients with completion of state and federal programs to help patient obtain and expedite benefit approval of hospital bill.
- Processed applications for different hospitals within an allotted turn around time.
- Input patient demographics and all proof of financials into the pace computer software.
- Assorted and prepared forms for copying, scanning to different agencies.
- Prepared disability applications for hand delivery to the social security office.
- Communicated well with co-workers, patients and families of all various educational and different backgrounds.
- Provided support to assistant manager, district manager, co-workers (including processing mail, call transfer, translating) professional, adhered to all phi and hipaa guidelines.
Experience
2-5 Years
Level
Executive
Education
BS Management
Claims Processor/ Account Rep Resume
Objective : Claims Processor is responsible for the processing of all claims. This includes entering and submitting claim information, following up on any questions from the customer, and making sure all insurance requirements are met.
Skills : Strategic Planning, Strong Organizational, Multi-Tasking, Google Docs, Data Entry, Detail Oriented, Communication, Computer
Description :
- Responsible for sorting and scanning incoming faxes and mail then filing the documents to the correct claim.
- Thoroughly review claims to ensure no missing or incomplete information.
- Possess extensive knowledge of medical terminology and how to read and assess medical documents.
- Process new insurance policies, modify existing claims and obtain information from policyholders to verify the accuracy of their claim and account.
- Responsible for printing, sorting, reviewing for accuracy, and mailing all outgoing daily mail.
- Possess excellent communication skills to converse with doctors offices or insurance companies if there is a problem with the claim.
- Communicate with clients, claimants, providers, team members and company representatives in terms of status.
Experience
2-5 Years
Level
Executive
Education
Diploma
Motor Claims Processor Resume
Objective : To obtain a Data entry or receptionist position utilizing the skills and education that I have acquired to provide excellent service.
Skills : Microsoft Word, Outlook, Acces, Excel
Description :
- Organize and processes complex/ non-routine property, casualty, and subrogation auto claims in a high volume claim environment.
- Applies claims settlement procedures to initiate payments and enter reserve requirements as necessary to process claims and close files.
- Communicates with team members, policyholders, claimants, and witnesses by telephone, email, and/or written correspondence to gather facts of loss to aid in claim resolution.
- Recognizes and reviews claims requiring specialized handling that may require the use of independent experts or vendors.
- Manage claim files, set assignments for vehicle inspections, rental vehicles, and the moving of vehicles to the salvage yard.
- Negotiate settlements with customers and lienholders, payout total loss settlements, and obtain necessary documents to process titles for branding and have salvage vehicles sold.
- Complies and prepares statistical tire and wheel claims data and reports.
Experience
0-2 Years
Level
Entry Level
Education
Bachelor of Science
Insurance Claims Processor Resume
Objective : I am interested in a position where there are no limitations to success, room for advancement, and interactive hands on atmosphere. I am in search of a job I may turn into a career. I am looking for a loyal employer that appreciates and recognizes the hard work I am willing to put in for the company.
Skills : Bilingual, Multi-Line Phone System, Multi-Tasking, Ms Word, Excel, Billing, Customer Service
Description :
- Processing medical insurance claims for health insurance claims, worker's compensation claims, auto claims, and disability claims.
- Process billing claims from non-medical transportation providers for multiple states.
- Works closely with tire and wheel adjusters to review and resolve payment issues that have been escalated.
- Prepares and print payment of claims and verifies payment has been made.
- Assists claims adjusters, clients, and customers with problems and/or questions regarding their claims status.
- Comply with state tax laws in applying applicable tax information pertaining to the tire and wheel product.
- Processed insurance claims here and also made calls to providers requesting information needed to get the claims thru.
Experience
2-5 Years
Level
Executive
Education
Diploma
Claims Processor Associate Resume
Summary : Highly motivated and organized professional seeking an employment opportunity in an environment where my experience and skills can be utilized and expanded. Strengths include being proactive, having a strong work ethic, and the ability to work well independently or in a team environment.
Skills : Microsoft Word, Powerpoint, Excel, All Internet Browsers, 55 Wpm
Description :
- Responsible for responding to routine inquiries by phone and correspondence was the biggest part of this job.
- Identify incorrectly processed claims and completes adjustments and related reprocessing actions.
- Determine whether to return, deny or pay claims following organizational policies and procedures.
- Ability to handle confidential or sensitive information with discretion all while having a working knowledge of Microsoft office.
- Research disputed claims on callers behalf to assist in liability decision.
- Resolved customers issues in regards to the settlement of claims not limited to arranging rentals, and payment for damage.
- Prepare insurance claim forms or related documents and review them for completeness.
Experience
7-10 Years
Level
Senior
Education
Diploma
Claims Processor Resume
Summary : Resourceful, self-directed support professional demonstrating pride in performance and successful work accomplishment. Strong customer service, problem solving, time management and organizational skills. Self-motivated, able to implement decisions and set effective priorities to achieve both immediate and long-term goals, Sound decision-making and interpersonal skills.
Skills : Microsoft Office, Claims Processing, Customer Service, Customer Relations, Bookkeeping, Banking.
Description :
- Taking phone calls, phone messages and dispersing the messages to the proper unit for handling.
- Getting the intial notification of the claim set up in claim system and moved to the right unit for the proper handling of the claim.
- Send payments for the claim, closing the claim handling, sending faxes, and sending proper paperwork to the persons involved in the claims.
- Maintain quality standards responsible to work suspended claims on a daily basis.
Responsible for processing personal inventory of claims to meet quota on a daily basis.Cross trained in total loss with knowledge of determining the appropriate value, salvage and issuing settlement checks. Conduct investigation, analyze outcome of investigation, and make appropriate liability decision.
Experience
10+ Years
Level
Senior
Education
BS Management
Auto Claims Processor Resume
Headline : To obtain an Auto Claims Processor position within an organization utilizing extensive organizational and multi-tasking skills along with excellent customer service in order to maximize productivity and efficiency.
Skills : Administrative, Customer Service, Data Entry.
Description :
- Served as the primary contact for customers fielding questions, responding to inquiries and providing timely updates on the status of claims.
- Created and delivered presentations utilizing a natural ability for public speaking and client engagement.
- Worked with interested parties including attorneys, witnesses, repair shops and service providers to investigate, negotiate and settle claims.
- Drafted and distributed written correspondence including letters, emails, memos and claims statements.
- Processed and filed claims and related information with attention to accuracy, organization and confidentiality.
- Utilized refined communication abilities to establish and strengthen relationships with clients.
- Exceeded established objectives consequently being ranked as one of the top ten processors.
Experience
5-7 Years
Level
Executive
Education
BA
Auto Claims Processor Resume
Headline : Highly-motivated problem-solver and decision maker. Well-versed in Insurance and Financial Services and expertise in Property and Casualty Claims environment (Auto). Superb communication and technical skills, and experience in leadership with personal accountability to customers and colleagues.
Skills : Inventory management, Payroll.
Description :
- Communicated with clients on a daily basis to access policy needs and relate policy language to their understanding.
- Made individual recommendations to best support client's needs.
- Acted as a rental liaison to keep team informed on rental procedures and assisting with rental problems.
- Acted as the team's On the ground team member to keep coworkers up to date with upcoming changes while ensuring successful implementation.
- Acted as subrogation captain to keep the team on track with the corporation's goals in fund management and any outstanding liabilities (A/R).
- Maintained positive working relationship with partnered vendors such as car insurance companies.
- Handled claims in NY and all of the New England states (VT, NH, CT, RI, ME, MA) Obtained and held liability adjuster's license in NY, NH, VT, CT, RI, TX, WY, SC, OK, DE, GA Determined minor accident liability decisions.
Experience
5-7 Years
Level
Junior
Education
MS
Auto Claims Processor Resume
Summary : To establish a long-term career in a company where I may utilize my Auto Claims Processor professional skills and knowledge to be an effective Associate Program Manager and inspiration to those around me.
Skills : Coaching/mentoring, Creating Training Curriculum, Customer Service, Customer Relations, Microsoft Office, Insurance, Decision Making, Money Management.
Description :
- Handled auto claims for 6 states.
- Had vehicles inspected or set up body shops to handle repairs.
- Took the most phone calls on my team for many years.
- Able to help train newcomers to our claim teams.
- Reviewed insurance policy terms to determine whether a particular auto claim is covered.
- Examined claims submitted by insured and third parties, or such claims referred from others.
- Processed claims assigned by claim management/claim specialist/representative and/or electronic assignment.
Experience
10+ Years
Level
Senior
Education
GED
Auto Claims Processor Resume
Objective : Conducting telephone interviews, corresponds with claimant and witnesses, review police and hospital records; and inspects property damage to determine extent of company's liability, varying method of investigation according to type of insurance.
Skills : Inventory Management, Purchasing, Manufacturing / Production.
Description :
- Handled incoming auto claim calls.
- Trained extensively for this position.
- Became ill and was no longer able to commute for the position.
- Worked in a team environment to assist the customer with low complexity auto claims by taking inbound and placing outbound phone calls.
- Consistently scored above average on phone and task production results.
- Obtained high production results while still maintaining customer focus and providing quality documentation in claims.
- Served as a Subrogation Team Captain.
Experience
2-5 Years
Level
Executive
Education
GED
