Claims Processor Resume Samples

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Claim Processors work in the insurance industry and are responsible for processing insurance claims. Common duties listed on a Claim Processor resume example are analyzing insurance information, performing data entry, handling insurance claims reimbursements, and deciding whether a claim should be processed or denied. Based on our most successful resume samples for Claim Processors, a successful candidate should demonstrate insurance claim expertise, analytical thinking, attention to details, communication and writing skills, and computer competencies. Most Claim Processors hold a Bachelor's Degree in a business-related field, although on-the-job training is usually provided by insurance companies.

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1

Claims Processor

  • Determined if claim submission was completed correctly, verified data and entered into system for adjudication
  • Worked directly with beneficiaries to resolve any errors and answer any questions regarding eligibility status
  • Reviewed payments history to determine final payment amount, if any
  • Translated foreign language claims into English utilizing translation software, then manually checked and coded appropriately
  • Processed claims adjustments when applicable
Candidate Info
15
years in
workforce
1
year
at this job
HS
High School Diploma
Psychology
Child Advocacy
2

Senior Claims Processor

  • Provided independent decision making skills and demonstrated initiatives to resolve issues for internal and external customers
  • Answered incoming calls while handling in-person inquiries
  • Composed and typed routine letters and documented file activity on a regular basis on the computer
  • Processed and handled new non technical claims
  • Performed clerical functions which included opening, sorting and distributing incoming mail and processing outgoing mail, copy work, handled office subpoenas, filing and assisted the unit and supervisor in multiple projects using expert time management with little supervision
  • Paid vendor statements and handled payment complaints and discrepancies
  • Processed checks, stop payments, cancellations, voids and journal entry payments
  • Scheduled appointments
Candidate Info
34
years in
workforce
34
years
at this job
3

Claims Processor

  • Research and process claims according the processing guidelines and benefits
  • Contact and follow up with members for additional correspondence
  • Responsible for accurate and timely daily reports
  • Assists with the training of new hires
  • Third Party Administrator knowledge and experience
  • Knowledge and use of ICD-9, ICD-10 and CPT coding
Candidate Info
8
years in
workforce
1
year
at this job
Certification

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