Insurance Claims Specialist Resume Samples

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Insurance Claims Specialists review client claims and determine whether or not they are covered under a policy. Main job responsibilities of an Insurance Claims Specialist include checking if proper filing procedures have been followed, collecting relevant information, approving or denying claims, and justifying their decisions. A well-written resume sample in the field should mention the following skills: negotiation, customer service, decision-making, commercial acumen, good numeracy skills, attention to details, and report-writing. Insurance companies choose resumes displaying a Bachelor's Degree and a license in the field.

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1

Insurance Claims Specialist

  • Handled and resolved multiple and complex dental billing issues.
  • Contacted insurance companies for claim follow-up.
  • Analyzed repetitive claim issues and acted accordingly.
  • Denial Management and Appeal
  • Worked in fast past environment
  • Experienced with insurance payers including Medicaid, Medicare, and other Commercial and Private payers.
  • Electronic Record Experience
Candidate Info
8
years in
workforce
6
months
at this job
AS
Medical Assisting
2

Insurance Claims Specialist

  • Insurance verification, understanding Eob's, Denials, appeals
  • Posting insurance payments and adjustments
  • Printing and mailing claims
  • Contacting Patients on balances, and verify insurance
  • Worked with insurance to reconcile claims for payment
Candidate Info
10
years in
workforce
2
years
at this job
Certification
3

Insurance Claims Specialist

  • Review incoming mail
  • Ensure data integrity with acquisitions.
  • Communicate to management acquisitions timelines, issues and concerns
  • Assist with Internal audit request/responses
  • Assist manger with developing and refining quality controls questions for processes reviews
  • Review POC's
Candidate Info
7
years in
workforce
1
year
at this job
4

Certified Insurance Claims Specialist

  • Processing of Demographics & Charges via download files and Epic Workques.
  • Research to obtain missing information such as ID#'s, authorizations, valid insurance via webpage and phone.
  • Identifies problems such as Diagnosis, multiple units, missing code or modifiers and place on hold or forward to the appropriate person for follow up.
  • Checks all accounts requiring admit dates to verify correct date of service, place of service, available documentation to support level of service billed and other claim inaccuracies.
  • Performs analysis and registration of patient accounts for submission of an accurate claim.
  • Maintains an efficient level of productivity with minimal error.
  • I was also responsible for training new claims specialists within the hospitalist charge entry team.
  • Promotes positive spirit of teamwork by helping others without the request of management.
Candidate Info
11
years in
workforce
2
years
at this job
HS
High School Diploma
5

Insurance Claims Specialist

Responsible for Insurance Denials

  • Posting co-pays, inputting insurance payments
  • Answering multi-line phones
  • Compliant with HIPPA
  • Utilizing EMR computer system
Candidate Info
26
years in
workforce
9
months
at this job
C
Medical Terminology
C
Basic Veterinary Assisting
6

PBD Insurance Claims Specialist

  • Responsible for following up on all insurance rejections and denials, both mail and electronic in order to facilitate reimbursement and for obtaining and medical documentation along with other vital information to insurance companies for re-evaluation of claims previously denied or reduced.
  • Uses investigative analysis skills in identifying patterns and/or trends in reimbursement or denials, appropriately bringing forth matters that impact the revenue cycle
  • Responsible for consistently meeting productivity requirements based on role/tasks. Completes a productivity log for all work done outside of ETM (Enterprise Task Manager) system
  • Effectively utilizes carrier websites and departmental resources for all questionable rejections, initiating calls to the carrier when deemed necessary (ex: claim lacks information)
  • Demands claims and determines the appropriate documentation required (e.g., operative reports, cover letters, pathology reports) per departmental guidelines, for accurate processing by insurance carriers
  • Responsible for adhering to billing and HIPPA regulations while processing invoices according to departmental and institutional policies and procedures
  • Submits electronic or paper claims to the appropriate carriers after updating the FSC (Financial Classification Status) list. Adjusts all credits or incorrect entries when reviewing accounts; demonstrate the ability to determine root causes of issues and prepares corresponding adjustment(s) on appropriate forms
  • Selects the appropriate ETM outcome after working on a claim and ensures that all actions are properly noted in the ETM system (Ex: call reference numbers, notes, outcomes etc). Appropriately escalates invoices in ETM to the correct department or individual.
Candidate Info
7
years in
workforce
1
year
at this job
BA
Mass Communications

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