A Claims Reviewer takes responsibility for reviewing insurance claims and to verify that the overall due processes are followed in the investigation. Typical duties seen on the Claims Reviewer Resume include the following – reviewing reports and to ensure that no errors are made in the appraisal process; determining if payouts are reasonable; approving or rejecting or referring claims; meeting with claimants and settling disputes; ensuring compliance with regulatory standards; providing assistance to claims adjusters; and consulting with specialists such as engineers, architects, physicians, and lawyers.
To be successful in this role, the Claims Reviewer should be able to demonstrate the following skills and abilities – sound administrative and organizational skills; great attention to details; proficiency with mathematics and spreadsheet software; decision-making skills; and excellent knowledge of the working industry. Employers don’t expect anything more than a high school diploma or GED.
Objective : To challenge personally and professionally in an analytical Claims Reviewer role with the potential for advancement of the organization.
Skills : Insurance Companies, Data Entry, Loss Statements.
Description :
Ensured proper training for 10 person team.
Acted as liaison between Claims Reviewers and Claims Management.
Handled hostile claimants at the lowest level, ensuring safety for all persons involved.
Provided assistance to claim handlers by performing a variety of support services (e.g., setting up claim files, filing correspondence, pulling files).
Entered claim information electronically.
Responded to customer inquiries and requests while resolving issues efficiently and professionally.
Performed receptionist and/or office switchboard duties as assigned.
Experience
0-2 Years
Level
Entry Level
Education
Bachelor's In Accounting
Medical Claims Reviewer Resume
Summary : Seeking a dedicated and professional work environment that will encourage growth and allow me to share knowledge in medical insurance and the medical coding field.
Skills : Claims Submissions, Data entry, Claims Information.
Description :
Processed various types of medical claims according to established procedures.
Interpreted contracts and policies, identified ineligible expenses, and inappropriate coding.
Identified and pended for review potential COB and/or third-party claims.
Identified issues that can adversely affect provider payments or member benefits.
Met or exceeded department production and quality standards.
Processed claims according to provider contracts and member benefits.
Reviewed training/education materials and seek clarification when needed.
Experience
7-10 Years
Level
Management
Education
GED
Finance Claims Reviewer Resume
Objective : Dedicated and technically skilled business professional with a versatile administrative support skill set developed through experience as an office manager, secretary, Claims Reviewer and office clerk.
Responsible for of claims data with tasks including data entry and related duties to ensure excellent client service.
Reviewed claims submissions, reviewed financial and/or medical records, and apply the complex methodology in order to value claims.
Reviewed claims in order to control of client databases through secondary review of claims information.
Provided information to the client and other counsel outside the firm.
Performed regular quality may include research of financial and medical terminology as well as financial documents and pharmaceuticals.
Applied completeness criteria to determine the completeness of required documentation.
Reviewed documents in order to evaluate and assign values to claims while maintaining the integrity information in order to generate correspondence and reports related to the status of claims submissions.
Experience
0-2 Years
Level
Entry Level
Education
BS In Finance
Claims Reviewer Resume
Headline : Seeking a position that will utilize technical knowledge, communication skills, and education. A team worker, who maintains exceptional productivity, attention to detail, and accepts responsibility willingly. Eager to learn all phases of a new job assignment or an internship opportunity with highly effective results.
Skills : Communication , Customer Service, Data entry.
Description :
Reviewed and used collateral verified documents to assess the validity of claims and conducted research as necessary, and documented details in a written report as required.
Researched and analyzed reports and use investigative skills when necessary to determine fraudulent and suspicious activity by law firms.
Investigated claims to find deficiencies and code appropriately.
Responsible for making decisions on the payout of claimants in Initial Review, Re-review, and Self--Audit while maintaining a high number in qualifying Production, Quality, and Release error rates which are mandated and set by the company.
Required to review and process asbestos-related injury claims in accordance with company policies and procedures specific to different trusts through resources provided, team leads, and managers.
Escalated issues as needed for advanced investigation and Work independently.
Applied communication skills to complex and non-routine issues by communicating informative and persuasive information.
Experience
5-7 Years
Level
Executive
Education
BA In Finance
Claims Reviewer Resume
Headline : An ambitious, energetic team member; able to improve daily operations and work efficiently A confident communicator; able to create positive working relationships with customers, co-workers and supervisors, A respectful associate; able to display company pride and encourage the team.
Skills : Claims Processing, Quality Assurance, Data Analysis, Research.
Description :
Performed data analysis, and verified medical and legal information.
Looked at the documentation to make sure that the claimant and adjusters followed company guidelines.
Verified analyzes data company uses to settle claims, with an eye on proving that claims are valid and payments are made based on companies' practices and procedures.
Focused on questionable claims to determine whether payment is warranted.
Made sure that filing has merit, pay, and process claim.
Entered claim payments, reserves, and new claims with accompanying file documents into the company computer system.
Organized and maintained records of settled claims and kept inventories of claims that acquire additional analysis.
Experience
5-7 Years
Level
Executive
Education
GED
Claims Reviewer Resume
Objective : Over 2 years of experience I reviewing claims, verifying accuracy on medical documents and entering information in the system, and sending correspondence to patients attorneys. Also, had an extensive banking background in customer service, credit analyst, and fraud analyst.
Skills : Microsoft Office, Client Database, Generate Correspondence/
Description :
Compiled quality control reports and performance statistics for the claims processing Ares.
Utilized ADA coding procedures to prepare dental claims for processing.
Entered claim data into a system utilizing seven distinct databases and three on-line reference libraries.
Adjudicated claims based upon contract terms and coverage guidelines with specific accountability for the timely and accurate processing of claims for a high profile government contract.
Processed eligibility confirmations dependents.
Analyzed claims submissions and applied completeness criteria to determine the completeness of the required documentation.
Reviewed financial and/or medical records and applied complex methodology in order to value claims.
Experience
2-5 Years
Level
Junior
Education
Diploma In Finance
Claims Reviewer Resume
Headline : Over 8 years of experience as Claims Reviewer, responsible for reviewing claims submitted through the Health claims processing systems. identify and rectify claim inaccuracies that would result in client over-payment.
Skills : Data Entry, MS Office, Generate Correspondence.
Description :
Reviewed claim submissions and apply criteria and determine the completeness of required data, Review financial and/or medical records, and apply the complex methodology in order to value claim proceed amounts.
Reviewed claims in order to provide information to the client and other counsel outside the firm.
Performed regular quality control of client databases through secondary review of claim information.
Completed search for financial and medical records as well as data entry of claims information.
Generated correspondence and reports related to the status of claim submissions.
Evaluated and investigated new claims assigned.
Reviewed medical and exposure documentation submitted by the law firms for claimants previously exposed to asbestos.
Input medical information including physical exams, pathology/autopsy reports, chest x-rays, and CT scans along with death certificates.
Examined employment information to verify a latency period of exposure were met and ensured that corporate policies, procedures, and Best Practices were followed in accordance with any statutory, regulatory, and ethics requirements.
Experience
5-7 Years
Level
Executive
Education
GED
Claims Reviewer Resume
Objective : Seeking an interesting Claims Reviewer position with a growing company that is both challenging and rewarding. A professional and dedicated employee that easily adapts to ever-changing work environments.
Skills : Microsoft Office, Generate Correspondence, Regular Quality Control.
Description :
Reviewed real property claims submitted by claimants affected by a major oil spill.
Reviewed and processed categorizing documents uploaded by the claimant, reviewing the registration form, claim form, deed, property tax assessment, and other pertinent.
Submitted documents and giving a summary of each claim and recommending it for compensation, an incompleteness notice, sending to supervisory review, or denying it.
Reviewed online claims in a paperless environment.
Reviewed claims after incompleteness notices have been sent and additional information is received from the claimant.
Worked closely with a team of claims reviewers and collaborate on difficult and unique claims.
Assisted Claimants in submitting Economic Loss claims and gathering supporting documentation to substantiate said claims.
Experience
0-2 Years
Level
Entry Level
Education
BS In Claims Reviewer
Claims Reviewer Resume
Objective : Diversified background; quick & willing learner; positive-collaborative attitude; computer literate; proven track record of excellence with clients & employers; calm under pressure.
Skills : Regular Quality Control, Insurance policies, Data Entry.
Description :
Resolved any conflicting information or pricing information.
Checked claims keyed by other reviewers for accuracy.
Reviewed claims and correspondence of medical Reviews.
Reviewed and analyzed documents for discovery and privilege in a large, complex breach of contract case.
Analyzed complex legal documents, including emails, contacts, and financial documents.
Determined which issues applied to each document and coded the documents accordingly.
Reviewed and determined if the document was responsive to the issues of the case and determined if any type of privilege applied.
Experience
0-2 Years
Level
Entry Level
Education
GED
Claims Reviewer Resume
Summary : Versatile and result in oriented Claims Reviewer Professional, with many years of diversified experience and demonstrated success in Account Management roles; Exceptional auditing and investigation expertise; Possessing solid problem solving and critical thinking abilities. Solid work ethic with a reputation for producing high-quality work.
Skills : MS Office, Management, Data entry, Communication Skills.
Description :
Audited and reviewed medical claims for overpayments.
Performed on-line auditing of Humana claims for accurate payment to proper providers.
Investigated asbestos-related injury claims, reviewed physician reports ensuring all physicians were certified and that claimants were properly.
Performed quality control measures on economic loss claim to ensure accuracy, trained new claimant assistants in customer service, and data entry.
Reviewed and assessed claimant medical records and legal documents for attorney final approval of settlement awards.
Researched medical terminology and procedures in order to verify qualified claimants for settlement awards and trained new associates.
Performed quality control measures for other employee assignments.
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