Insurance Claims Processor Resume Samples

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Insurance Claims Processors review applications for insurance and either approve or deny these claims based on a set of criteria. Common duties seen on an Insurance Claims Processor resume example are reviewing insurance policies, determining the type of coverage, preparing claim forms, making sure files are complete, asking for information from clients, and paying checks to clients. The ideal candidate should be able to showcase in his or her resume insurance processing experience, attention to details, customer service orientation, time management, confidentiality, and organizational skills. Employers select candidates holding a degree in finance or a similar field.

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1

Insurance Claims Processor

Appointment Specialist

  • Managed the front desk and supported personnel where needed
  • Monitored updates in the insurance industry in order to make sure that claims were submitted in a timely and efficient manner thereby assuring expedited payments.
  • Credentialed all new doctors
  • Spent most of time resolving problems to get claims paid
  • Posted and balanced all money received from insurance companies
Candidate Info
22
years in
workforce
14
years
at this job
C
Business And Office Education
2

Insurance Claims Processor

  • Facilitated the resolution of workers compensation and property & casualty claims by acting as liaison between clients, adjusters and other parties involved in the claim management process.
  • Provided focused oversight of workers’ compensation claims that have been deemed high priority claims.
  • Attended team/department meetings, and applicable educational training workshops as established by management.
  • Initiated (First-Notice-of-Loss) claims for AIG's private client group and high net-worth clientele.
  • Maintained a daily activity tracking log –processing results.
  • Conducted compliance auditing for the state of New York.
Candidate Info
10
years in
workforce
1
year
at this job
Communications/business Administration
3

Insurance Claims Processor

Achieved the transition of the company to paperless environment.

  • Calculated and posted customer's monthly insurance payments.
  • Supported claim adjusters with ordering police reports, scheduling doctor's appointments.
  • Trained new employees.
  • Dispersed all mail to appropriate departments through indexing.
  • Provided support within the overall company when needed.
Candidate Info
12
years in
workforce
9
years
at this job
AA
Accounting
4

Insurance Claims Processor

Process daily incoming health, dental and vision insurance claims for 12 different groups throughout the state while maintaining a 99% accuracy rate with all processed claims

  • Batch/enter paper HICFA and UB claim received into system for processing
  • Communicate with groups about members coverage and any problems associated with them.
  • Verify and load new physicians and facility in software system
  • Scan all paper received in office to designated files
  • Work reports dealing with status of claims that have been submitted and report back to Anthem.
  • Review of medical records for claims processing
Candidate Info
8
years in
workforce
2
years
at this job
Medical Billing And Coding
5

Insurance Claims Processor

Communicate with families regarding required insurance documentation

  • Check eligibility and benefits monthly for 100+ clients
  • Complete CMS 1500 claims forms and submit to insurance companies for payment
  • Review and edit claims for accuracy
  • Invoice all insurance and co-payments
  • Copy, scan, file
  • Research all payment from insurance companies and families
Candidate Info
6
years in
workforce
2
years
at this job
C
Medical Office Administration
6

Health Insurance Claims Processor

  • Provided customer service to insurance members, health providers, billing questions, complaints, follow ups.
  • Handle a high volume of 80 incoming calls and 30 incoming emails within a deadline driven environment.
  • Experienced with Microsoft word, excel, power point, outlook.
  • Accurately input data entry of medical & hospital claims information into processing system.
  • Knowledge of Medical terminology, ICD9, CPT, HCPS codes, paid or rejected health insurance claims.
Candidate Info
14
years in
workforce
10
years
at this job
AAS
Health Administration
BA
Health Management
7

Insurance Claims Processor

  • Resolve an average of 200 health insurance claims per day
  • Resolve claims accurately and efficiently
  • Achieve monthly individual and team metric goals
  • Assist with process improvement ideas and implementation
Candidate Info
19
years in
workforce
5
years
at this job
HS
High School Diploma
8

Insurance Claims Processor

  • Effectively processed Personal Injury Protection/Large Loss Claims for House Counsel and Subpoena request according to HIPAA.
  • Dedicated customer service, sales and influence.
  • Team orientated Call Center work environment.
  • Effective customer resolution and problem solving.
  • Dynamic verbal /written communication and excellent computer skills.
Candidate Info
28
years in
workforce
2
years
at this job
BS
Health Science
9

Insurance Claims Processor

  • Receive claim assignments, confirm coverage, and investigate claim
  • Determine liability, assess damage, create estimate for related damage and pay claim
  • Manage claim during repairs with body shops and other contractors
  • Maintain excellent communication and customer service during claim process
  • Excellent dispute resolution skills
Candidate Info
7
years in
workforce
7
years
at this job
BS
Agricultural Development
10

Hazard Insurance Claims Processor

  • Process insurance loss claims
  • Inform homeowners on claims processes & procedures
  • Insure that correct documentation is received to monitor or endorse and release claim funds
  • Calculate and disburse claim funds according to appreciate payment schedule
  • Submit recommendation for exceptions to payment disbursement guidelines to management
  • Constant use of excellent customer service, team player, analytical and decision making skills when handling claims
Candidate Info
13
years in
workforce
6
years
at this job
AS
Medical Assisting
BS
Technical Management
Medical Front Office Certification

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